FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

13.1 Resource Coverage - Content

Financial Management

Work Group

Maturity Level: 2

Trial Use

Compartments: Patient, RelatedPerson

Financial instrument which may be used to reimburse or pay for health care products and services.

13.1.1 Scope and Usage

The Coverage resource is intended to provide the high level identifiers and potentially descriptors of an insurance plan which may used to pay for, in part or in whole, the provision of health care products and services.

This resource may also be used to register 'SelfPay' where an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs.

This resource is referenced by Account, Claim, ClaimResponse, EligibilityRequest, EligibilityResponse, EnrollmentRequest and ExplanationOfBenefit

Structure

Name	Flags	Card.	Type	Description & Constraints
Coverage			DomainResource	Insurance or medical plan or a payment agreement Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	The primary coverage ID
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
type	Σ	0..1	CodeableConcept	Type of coverage such as medical or accident Coverage Type and Self-Pay Codes (Preferred)
policyHolder	Σ	0..1	Reference(Patient \| RelatedPerson \| Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the Subscriber
beneficiary	Σ	0..1	Reference(Patient)	Plan Beneficiary
relationship		0..1	CodeableConcept	Beneficiary relationship to the Subscriber Policyholder Relationship Codes (Example)
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	0..*	Reference(Organization \| Patient \| RelatedPerson)	Identifier for the plan or agreement issuer
grouping		0..1	BackboneElement	Additional coverage classifications
group	Σ	0..1	string	An identifier for the group
groupDisplay	Σ	0..1	string	Display text for an identifier for the group
subGroup	Σ	0..1	string	An identifier for the subsection of the group
subGroupDisplay	Σ	0..1	string	Display text for the subsection of the group
plan	Σ	0..1	string	An identifier for the plan
planDisplay	Σ	0..1	string	Display text for the plan
subPlan	Σ	0..1	string	An identifier for the subsection of the plan
subPlanDisplay	Σ	0..1	string	Display text for the subsection of the plan
class	Σ	0..1	string	An identifier for the class
classDisplay	Σ	0..1	string	Display text for the class
subClass	Σ	0..1	string	An identifier for the subsection of the class
subClassDisplay	Σ	0..1	string	Display text for the subsection of the subclass
dependent	Σ	0..1	string	Dependent number
sequence	Σ	0..1	string	The plan instance or sequence counter
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

UML Diagram (Legend)

XML Template

<Coverage xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier The primary coverage ID --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type of coverage such as medical or accident --></type>
 <policyHolder><!-- 0..1 Reference(Patient|RelatedPerson|Organization) Owner of the policy --></policyHolder>
 <subscriber><!-- 0..1 Reference(Patient|RelatedPerson) Subscriber to the policy --></subscriber>
 <subscriberId value="[string]"/><!-- 0..1 ID assigned to the Subscriber -->
 <beneficiary><!-- 0..1 Reference(Patient) Plan Beneficiary --></beneficiary>
 <relationship><!-- 0..1 CodeableConcept Beneficiary relationship to the Subscriber --></relationship>
 <period><!-- 0..1 Period Coverage start and end dates --></period>
 <payor><!-- 0..* Reference(Organization|Patient|RelatedPerson) Identifier for the plan or agreement issuer --></payor>
 <grouping>  <!-- 0..1 Additional coverage classifications -->
  <group value="[string]"/><!-- 0..1 An identifier for the group -->
  <groupDisplay value="[string]"/><!-- 0..1 Display text for an identifier for the group -->
  <subGroup value="[string]"/><!-- 0..1 An identifier for the subsection of the group -->
  <subGroupDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the group -->
  <plan value="[string]"/><!-- 0..1 An identifier for the plan -->
  <planDisplay value="[string]"/><!-- 0..1 Display text for the plan -->
  <subPlan value="[string]"/><!-- 0..1 An identifier for the subsection of the plan -->
  <subPlanDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the plan -->
  <class value="[string]"/><!-- 0..1 An identifier for the class -->
  <classDisplay value="[string]"/><!-- 0..1 Display text for the class -->
  <subClass value="[string]"/><!-- 0..1 An identifier for the subsection of the class -->
  <subClassDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the subclass -->
 </grouping>
 <dependent value="[string]"/><!-- 0..1 Dependent number -->
 <sequence value="[string]"/><!-- 0..1 The plan instance or sequence counter -->
 <order value="[positiveInt]"/><!-- 0..1 Relative order of the coverage -->
 <network value="[string]"/><!-- 0..1 Insurer network -->
 <contract><!-- 0..* Reference(Contract) Contract details --></contract>
</Coverage>

JSON Template

{
  "resourceType" : "Coverage",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // The primary coverage ID
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type of coverage such as medical or accident
  "policyHolder" : { Reference(Patient|RelatedPerson|Organization) }, // Owner of the policy
  "subscriber" : { Reference(Patient|RelatedPerson) }, // Subscriber to the policy
  "subscriberId" : "<string>", // ID assigned to the Subscriber
  "beneficiary" : { Reference(Patient) }, // Plan Beneficiary
  "relationship" : { CodeableConcept }, // Beneficiary relationship to the Subscriber
  "period" : { Period }, // Coverage start and end dates
  "payor" : [{ Reference(Organization|Patient|RelatedPerson) }], // Identifier for the plan or agreement issuer
  "grouping" : { // Additional coverage classifications
    "group" : "<string>", // An identifier for the group
    "groupDisplay" : "<string>", // Display text for an identifier for the group
    "subGroup" : "<string>", // An identifier for the subsection of the group
    "subGroupDisplay" : "<string>", // Display text for the subsection of the group
    "plan" : "<string>", // An identifier for the plan
    "planDisplay" : "<string>", // Display text for the plan
    "subPlan" : "<string>", // An identifier for the subsection of the plan
    "subPlanDisplay" : "<string>", // Display text for the subsection of the plan
    "class" : "<string>", // An identifier for the class
    "classDisplay" : "<string>", // Display text for the class
    "subClass" : "<string>", // An identifier for the subsection of the class
    "subClassDisplay" : "<string>" // Display text for the subsection of the subclass
  },
  "dependent" : "<string>", // Dependent number
  "sequence" : "<string>", // The plan instance or sequence counter
  "order" : "<positiveInt>", // Relative order of the coverage
  "network" : "<string>", // Insurer network
  "contract" : [{ Reference(Contract) }] // Contract details
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Coverage;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Coverage.identifier [ Identifier ], ... ; # 0..* The primary coverage ID
  fhir:Coverage.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:Coverage.type [ CodeableConcept ]; # 0..1 Type of coverage such as medical or accident
  fhir:Coverage.policyHolder [ Reference(Patient|RelatedPerson|Organization) ]; # 0..1 Owner of the policy
  fhir:Coverage.subscriber [ Reference(Patient|RelatedPerson) ]; # 0..1 Subscriber to the policy
  fhir:Coverage.subscriberId [ string ]; # 0..1 ID assigned to the Subscriber
  fhir:Coverage.beneficiary [ Reference(Patient) ]; # 0..1 Plan Beneficiary
  fhir:Coverage.relationship [ CodeableConcept ]; # 0..1 Beneficiary relationship to the Subscriber
  fhir:Coverage.period [ Period ]; # 0..1 Coverage start and end dates
  fhir:Coverage.payor [ Reference(Organization|Patient|RelatedPerson) ], ... ; # 0..* Identifier for the plan or agreement issuer
  fhir:Coverage.grouping [ # 0..1 Additional coverage classifications
    fhir:Coverage.grouping.group [ string ]; # 0..1 An identifier for the group
    fhir:Coverage.grouping.groupDisplay [ string ]; # 0..1 Display text for an identifier for the group
    fhir:Coverage.grouping.subGroup [ string ]; # 0..1 An identifier for the subsection of the group
    fhir:Coverage.grouping.subGroupDisplay [ string ]; # 0..1 Display text for the subsection of the group
    fhir:Coverage.grouping.plan [ string ]; # 0..1 An identifier for the plan
    fhir:Coverage.grouping.planDisplay [ string ]; # 0..1 Display text for the plan
    fhir:Coverage.grouping.subPlan [ string ]; # 0..1 An identifier for the subsection of the plan
    fhir:Coverage.grouping.subPlanDisplay [ string ]; # 0..1 Display text for the subsection of the plan
    fhir:Coverage.grouping.class [ string ]; # 0..1 An identifier for the class
    fhir:Coverage.grouping.classDisplay [ string ]; # 0..1 Display text for the class
    fhir:Coverage.grouping.subClass [ string ]; # 0..1 An identifier for the subsection of the class
    fhir:Coverage.grouping.subClassDisplay [ string ]; # 0..1 Display text for the subsection of the subclass
  ];
  fhir:Coverage.dependent [ string ]; # 0..1 Dependent number
  fhir:Coverage.sequence [ string ]; # 0..1 The plan instance or sequence counter
  fhir:Coverage.order [ positiveInt ]; # 0..1 Relative order of the coverage
  fhir:Coverage.network [ string ]; # 0..1 Insurer network
  fhir:Coverage.contract [ Reference(Contract) ], ... ; # 0..* Contract details
]

Changes since DSTU2

Coverage

Coverage.status

Added Element

Coverage.type

Type changed from Coding to CodeableConcept

Coverage.policyHolder

Added Element

Coverage.subscriber

Add Reference(RelatedPerson)
No longer marked as Modifier

Coverage.subscriberId

Type changed from Identifier to string

Coverage.beneficiary

Added Element

Coverage.relationship

Added Element

Coverage.payor

Added Element

Coverage.grouping

Added Element

Coverage.grouping.group

Added Element

Coverage.grouping.groupDisplay

Added Element

Coverage.grouping.subGroup

Added Element

Coverage.grouping.subGroupDisplay

Added Element

Coverage.grouping.plan

Added Element

Coverage.grouping.planDisplay

Added Element

Coverage.grouping.subPlan

Added Element

Coverage.grouping.subPlanDisplay

Added Element

Coverage.grouping.class

Added Element

Coverage.grouping.classDisplay

Added Element

Coverage.grouping.subClass

Added Element

Coverage.grouping.subClassDisplay

Added Element

Coverage.dependent

Type changed from positiveInt to string

Coverage.sequence

Type changed from positiveInt to string

Coverage.order

Added Element

Coverage.network

Type changed from Identifier to string

Coverage.issuer

deleted

Coverage.bin

deleted

Coverage.group

deleted

Coverage.plan

deleted

Coverage.subPlan

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

Structure

Name	Flags	Card.	Type	Description & Constraints
Coverage			DomainResource	Insurance or medical plan or a payment agreement Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	The primary coverage ID
status	?!Σ	0..1	code	active \| cancelled \| draft \| entered-in-error Financial Resource Status Codes (Required)
type	Σ	0..1	CodeableConcept	Type of coverage such as medical or accident Coverage Type and Self-Pay Codes (Preferred)
policyHolder	Σ	0..1	Reference(Patient \| RelatedPerson \| Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient \| RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the Subscriber
beneficiary	Σ	0..1	Reference(Patient)	Plan Beneficiary
relationship		0..1	CodeableConcept	Beneficiary relationship to the Subscriber Policyholder Relationship Codes (Example)
period	Σ	0..1	Period	Coverage start and end dates
payor	Σ	0..*	Reference(Organization \| Patient \| RelatedPerson)	Identifier for the plan or agreement issuer
grouping		0..1	BackboneElement	Additional coverage classifications
group	Σ	0..1	string	An identifier for the group
groupDisplay	Σ	0..1	string	Display text for an identifier for the group
subGroup	Σ	0..1	string	An identifier for the subsection of the group
subGroupDisplay	Σ	0..1	string	Display text for the subsection of the group
plan	Σ	0..1	string	An identifier for the plan
planDisplay	Σ	0..1	string	Display text for the plan
subPlan	Σ	0..1	string	An identifier for the subsection of the plan
subPlanDisplay	Σ	0..1	string	Display text for the subsection of the plan
class	Σ	0..1	string	An identifier for the class
classDisplay	Σ	0..1	string	Display text for the class
subClass	Σ	0..1	string	An identifier for the subsection of the class
subClassDisplay	Σ	0..1	string	Display text for the subsection of the subclass
dependent	Σ	0..1	string	Dependent number
sequence	Σ	0..1	string	The plan instance or sequence counter
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

UML Diagram (Legend)

XML Template

<Coverage xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier The primary coverage ID --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type of coverage such as medical or accident --></type>
 <policyHolder><!-- 0..1 Reference(Patient|RelatedPerson|Organization) Owner of the policy --></policyHolder>
 <subscriber><!-- 0..1 Reference(Patient|RelatedPerson) Subscriber to the policy --></subscriber>
 <subscriberId value="[string]"/><!-- 0..1 ID assigned to the Subscriber -->
 <beneficiary><!-- 0..1 Reference(Patient) Plan Beneficiary --></beneficiary>
 <relationship><!-- 0..1 CodeableConcept Beneficiary relationship to the Subscriber --></relationship>
 <period><!-- 0..1 Period Coverage start and end dates --></period>
 <payor><!-- 0..* Reference(Organization|Patient|RelatedPerson) Identifier for the plan or agreement issuer --></payor>
 <grouping>  <!-- 0..1 Additional coverage classifications -->
  <group value="[string]"/><!-- 0..1 An identifier for the group -->
  <groupDisplay value="[string]"/><!-- 0..1 Display text for an identifier for the group -->
  <subGroup value="[string]"/><!-- 0..1 An identifier for the subsection of the group -->
  <subGroupDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the group -->
  <plan value="[string]"/><!-- 0..1 An identifier for the plan -->
  <planDisplay value="[string]"/><!-- 0..1 Display text for the plan -->
  <subPlan value="[string]"/><!-- 0..1 An identifier for the subsection of the plan -->
  <subPlanDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the plan -->
  <class value="[string]"/><!-- 0..1 An identifier for the class -->
  <classDisplay value="[string]"/><!-- 0..1 Display text for the class -->
  <subClass value="[string]"/><!-- 0..1 An identifier for the subsection of the class -->
  <subClassDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the subclass -->
 </grouping>
 <dependent value="[string]"/><!-- 0..1 Dependent number -->
 <sequence value="[string]"/><!-- 0..1 The plan instance or sequence counter -->
 <order value="[positiveInt]"/><!-- 0..1 Relative order of the coverage -->
 <network value="[string]"/><!-- 0..1 Insurer network -->
 <contract><!-- 0..* Reference(Contract) Contract details --></contract>
</Coverage>

JSON Template

{
  "resourceType" : "Coverage",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // The primary coverage ID
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type of coverage such as medical or accident
  "policyHolder" : { Reference(Patient|RelatedPerson|Organization) }, // Owner of the policy
  "subscriber" : { Reference(Patient|RelatedPerson) }, // Subscriber to the policy
  "subscriberId" : "<string>", // ID assigned to the Subscriber
  "beneficiary" : { Reference(Patient) }, // Plan Beneficiary
  "relationship" : { CodeableConcept }, // Beneficiary relationship to the Subscriber
  "period" : { Period }, // Coverage start and end dates
  "payor" : [{ Reference(Organization|Patient|RelatedPerson) }], // Identifier for the plan or agreement issuer
  "grouping" : { // Additional coverage classifications
    "group" : "<string>", // An identifier for the group
    "groupDisplay" : "<string>", // Display text for an identifier for the group
    "subGroup" : "<string>", // An identifier for the subsection of the group
    "subGroupDisplay" : "<string>", // Display text for the subsection of the group
    "plan" : "<string>", // An identifier for the plan
    "planDisplay" : "<string>", // Display text for the plan
    "subPlan" : "<string>", // An identifier for the subsection of the plan
    "subPlanDisplay" : "<string>", // Display text for the subsection of the plan
    "class" : "<string>", // An identifier for the class
    "classDisplay" : "<string>", // Display text for the class
    "subClass" : "<string>", // An identifier for the subsection of the class
    "subClassDisplay" : "<string>" // Display text for the subsection of the subclass
  },
  "dependent" : "<string>", // Dependent number
  "sequence" : "<string>", // The plan instance or sequence counter
  "order" : "<positiveInt>", // Relative order of the coverage
  "network" : "<string>", // Insurer network
  "contract" : [{ Reference(Contract) }] // Contract details
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Coverage;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Coverage.identifier [ Identifier ], ... ; # 0..* The primary coverage ID
  fhir:Coverage.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:Coverage.type [ CodeableConcept ]; # 0..1 Type of coverage such as medical or accident
  fhir:Coverage.policyHolder [ Reference(Patient|RelatedPerson|Organization) ]; # 0..1 Owner of the policy
  fhir:Coverage.subscriber [ Reference(Patient|RelatedPerson) ]; # 0..1 Subscriber to the policy
  fhir:Coverage.subscriberId [ string ]; # 0..1 ID assigned to the Subscriber
  fhir:Coverage.beneficiary [ Reference(Patient) ]; # 0..1 Plan Beneficiary
  fhir:Coverage.relationship [ CodeableConcept ]; # 0..1 Beneficiary relationship to the Subscriber
  fhir:Coverage.period [ Period ]; # 0..1 Coverage start and end dates
  fhir:Coverage.payor [ Reference(Organization|Patient|RelatedPerson) ], ... ; # 0..* Identifier for the plan or agreement issuer
  fhir:Coverage.grouping [ # 0..1 Additional coverage classifications
    fhir:Coverage.grouping.group [ string ]; # 0..1 An identifier for the group
    fhir:Coverage.grouping.groupDisplay [ string ]; # 0..1 Display text for an identifier for the group
    fhir:Coverage.grouping.subGroup [ string ]; # 0..1 An identifier for the subsection of the group
    fhir:Coverage.grouping.subGroupDisplay [ string ]; # 0..1 Display text for the subsection of the group
    fhir:Coverage.grouping.plan [ string ]; # 0..1 An identifier for the plan
    fhir:Coverage.grouping.planDisplay [ string ]; # 0..1 Display text for the plan
    fhir:Coverage.grouping.subPlan [ string ]; # 0..1 An identifier for the subsection of the plan
    fhir:Coverage.grouping.subPlanDisplay [ string ]; # 0..1 Display text for the subsection of the plan
    fhir:Coverage.grouping.class [ string ]; # 0..1 An identifier for the class
    fhir:Coverage.grouping.classDisplay [ string ]; # 0..1 Display text for the class
    fhir:Coverage.grouping.subClass [ string ]; # 0..1 An identifier for the subsection of the class
    fhir:Coverage.grouping.subClassDisplay [ string ]; # 0..1 Display text for the subsection of the subclass
  ];
  fhir:Coverage.dependent [ string ]; # 0..1 Dependent number
  fhir:Coverage.sequence [ string ]; # 0..1 The plan instance or sequence counter
  fhir:Coverage.order [ positiveInt ]; # 0..1 Relative order of the coverage
  fhir:Coverage.network [ string ]; # 0..1 Insurer network
  fhir:Coverage.contract [ Reference(Contract) ], ... ; # 0..* Contract details
]

Changes since DSTU2

Coverage

Coverage.status

Added Element

Coverage.type

Type changed from Coding to CodeableConcept

Coverage.policyHolder

Added Element

Coverage.subscriber

Add Reference(RelatedPerson)
No longer marked as Modifier

Coverage.subscriberId

Type changed from Identifier to string

Coverage.beneficiary

Added Element

Coverage.relationship

Added Element

Coverage.payor

Added Element

Coverage.grouping

Added Element

Coverage.grouping.group

Added Element

Coverage.grouping.groupDisplay

Added Element

Coverage.grouping.subGroup

Added Element

Coverage.grouping.subGroupDisplay

Added Element

Coverage.grouping.plan

Added Element

Coverage.grouping.planDisplay

Added Element

Coverage.grouping.subPlan

Added Element

Coverage.grouping.subPlanDisplay

Added Element

Coverage.grouping.class

Added Element

Coverage.grouping.classDisplay

Added Element

Coverage.grouping.subClass

Added Element

Coverage.grouping.subClassDisplay

Added Element

Coverage.dependent

Type changed from positiveInt to string

Coverage.sequence

Type changed from positiveInt to string

Coverage.order

Added Element

Coverage.network

Type changed from Identifier to string

Coverage.issuer

deleted

Coverage.bin

deleted

Coverage.group

deleted

Coverage.plan

deleted

Coverage.subPlan

deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

13.1.2.1 Terminology Bindings

Path	Definition	Type	Reference
Coverage.status	A code specifying the state of the resource instance.	Required	Financial Resource Status Codes
Coverage.type	The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.	Preferred	Coverage Type and Self-Pay Codes
Coverage.relationship	The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).	Example	Policyholder Relationship Codes

Path

Definition

Type

Reference

Coverage.status

A code specifying the state of the resource instance.

Required

Financial Resource Status Codes

Coverage.type

The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

Preferred

Coverage Type and Self-Pay Codes

Coverage.relationship

The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).

Example

Policyholder Relationship Codes

13.1.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
beneficiary	reference	Covered party	Coverage.beneficiary (Patient)
class	string	Class identifier	Coverage.grouping.class
dependent	string	Dependent number	Coverage.dependent
group	string	Group identifier	Coverage.grouping.group
identifier	token	The primary identifier of the insured and the coverage	Coverage.identifier
payor	reference	The identity of the insurer or party paying for services	Coverage.payor (Organization, Patient, RelatedPerson)
plan	string	A plan or policy identifier	Coverage.grouping.plan
policy-holder	reference	Reference to the policyholder	Coverage.policyHolder (Organization, Patient, RelatedPerson)
sequence	string	Sequence number	Coverage.sequence
subclass	string	Sub-class identifier	Coverage.grouping.subClass
subgroup	string	Sub-group identifier	Coverage.grouping.subGroup
subplan	string	Sub-plan identifier	Coverage.grouping.subPlan
subscriber	reference	Reference to the subscriber	Coverage.subscriber (Patient, RelatedPerson)
type	token	The kind of coverage (health plan, auto, Workers Compensation)	Coverage.type