VGR-SE Reimbursement Implementation Guide
0.8.0 - qa
This page is part of the VGR Reimbursement Implementation Guide (v0.8.0: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions
| Official URL: https://fhir.vgregion.se/ig/reimbursement/StructureDefinition/VGRReimbursementCoverage | Version: 0.8.0 | |||
| Draft as of 2026-05-07 | Computable Name: VGRReimbursementCoverage | |||
The Coverage-resource profiled for Healthcare Reimbursement in VGR. Coverage represents a Payment Commitment (betalningsförbindelse), issued by a Payment Commitment Issuer (utfärdare av betalningsförbindelse). NB: Payor is constrained to 1..1 and must point to the contained instance of VGRPayorOrganizationPlaceholder. This is to handle the fact that the actual Payor organization is not neccessarily known in all Reimbursement use cases.
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
![]() ![]() ![]() |
SΣ | 0..1 | string | The value that is unique Example General: 123456 |
![]() ![]() ![]() |
SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) |
![]() ![]() |
SΣ | 1..1 | Reference(VGRBasePatient) | Plan beneficiary |
![]() ![]() |
SΣ | 1..* | Reference(Organization) | Issuer of the policy |
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
||||
![]() ![]() ![]() |
S | 0..1 | string | The value that is unique |
![]() ![]() ![]() |
S | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
![]() ![]() ![]() ![]() |
0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) | |
![]() ![]() |
S | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) |
![]() ![]() |
S | 1..1 | Reference(VGRBasePatient) | Plan beneficiary |
![]() ![]() |
S | 1..* | Reference(Organization) | Issuer of the policy |
![]() ![]() ![]() |
0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder | |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() |
Σ | 0..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. | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() |
SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() |
SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) | ||||
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() |
SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() |
SΣ | 1..1 | Reference(VGRBasePatient) | Plan beneficiary | ||||
![]() ![]() |
Σ | 0..1 | string | Dependent number | ||||
![]() ![]() |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() |
Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() |
SΣ | 1..* | Reference(Organization) | Issuer of the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder | ||||
![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource | ||||
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Human readable description of the type and value | ||||
![]() ![]() |
Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
![]() ![]() |
Σ | 0..1 | string | Insurer network | ||||
![]() ![]() |
0..* | BackboneElement | Patient payments for services/products | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
![]() ![]() ![]() |
Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
![]() ![]() ![]() ![]() |
Quantity(SimpleQuantity) | |||||||
![]() ![]() ![]() ![]() |
Money | |||||||
![]() ![]() ![]() |
0..* | BackboneElement | Exceptions for patient payments | |||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() |
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. | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Period | The effective period of the exception | ||||
![]() ![]() |
0..1 | boolean | Reimbursement to insurer | |||||
![]() ![]() |
0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored |
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
![]() ![]() ![]() |
SΣ | 0..1 | string | The value that is unique Example General: 123456 |
![]() ![]() ![]() |
SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) |
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() |
SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) |
![]() ![]() |
SΣ | 1..1 | Reference(VGRBasePatient) | Plan beneficiary |
![]() ![]() |
SΣ | 1..* | Reference(Organization) | Issuer of the policy |
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from Coverage
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() |
||||
![]() ![]() ![]() |
S | 0..1 | string | The value that is unique |
![]() ![]() ![]() |
S | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
![]() ![]() ![]() ![]() |
0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) | |
![]() ![]() |
S | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) |
![]() ![]() |
S | 1..1 | Reference(VGRBasePatient) | Plan beneficiary |
![]() ![]() |
S | 1..* | Reference(Organization) | Issuer of the policy |
![]() ![]() ![]() |
0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder | |
Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() | ||||
|---|---|---|---|---|---|---|---|---|
![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |||||
![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
![]() ![]() |
0..* | Resource | Contained, inline Resources | |||||
![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
![]() ![]() ![]() |
Σ | 0..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. | ||||
![]() ![]() ![]() |
Σ | 0..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient | ||||
![]() ![]() ![]() |
SΣ | 0..1 | string | The value that is unique Example General: 123456 | ||||
![]() ![]() ![]() |
Σ | 0..1 | Period | Time period when id is/was valid for use | ||||
![]() ![]() ![]() |
SΣ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) | ||||
![]() ![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
![]() ![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource Binding: UtfardareAvBetalningsforbindelseVS (required) | ||||
![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
![]() ![]() |
SΣ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: TypeOfCoverageVS (extensible) | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
![]() ![]() |
Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
![]() ![]() |
Σ | 0..1 | string | ID assigned to the subscriber | ||||
![]() ![]() |
SΣ | 1..1 | Reference(VGRBasePatient) | Plan beneficiary | ||||
![]() ![]() |
Σ | 0..1 | string | Dependent number | ||||
![]() ![]() |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
![]() ![]() |
Σ | 0..1 | Period | Coverage start and end dates | ||||
![]() ![]() |
SΣ | 1..* | Reference(Organization) | Issuer of the policy | ||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL Required Pattern: #VGRPayorOrganizationPlaceholder | ||||
![]() ![]() ![]() |
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). | ||||
![]() ![]() ![]() |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
![]() ![]() ![]() |
Σ | 0..1 | string | Text alternative for the resource | ||||
![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |||||
![]() ![]() ![]() |
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() |
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
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Σ | 1..1 | string | Value associated with the type | ||||
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Σ | 0..1 | string | Human readable description of the type and value | ||||
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Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
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Σ | 0..1 | string | Insurer network | ||||
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0..* | BackboneElement | Patient payments for services/products | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
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Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
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Quantity(SimpleQuantity) | |||||||
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Money | |||||||
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0..* | BackboneElement | Exceptions for patient payments | |||||
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0..1 | string | Unique id for inter-element referencing | |||||
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0..* | Extension | Additional content defined by implementations | |||||
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?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
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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. | ||||
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Σ | 0..1 | Period | The effective period of the exception | ||||
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0..1 | boolean | Reimbursement to insurer | |||||
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0..* | Reference(Contract) | Contract details | |||||
Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.type | Base | extensible | IdentifierType | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.identifier.assigner.display | Base | required | UtfardareAvBetalningsforbindelseVS | 📦0.8.0 | This IG |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | extensible | TypeOfCoverageVS | 📦0.8.0 | This IG |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | Coverage | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron