Overview

Coverage is scoped per prescription and referenced via ServiceRequest.insurance on register-prescription ServiceRequests.

The Coverage defines who will be billed for the prescription and can either be an insurance specified in the Coverage or a Patient referenced in the Coverage.

Identifier

The identifier allows setting additional insurance information about the patient. TRxHub itself does not store the identifiers but only forwards them to the Mediservice ERP. Therefore, when reading a Coverage, the identifiers won't be returned.

Types

Coverage has either type insurance or self-pay which specifies who will be billed for the prescription.

Payor

The Payor is the insurer or patient who will be billed for the prescription.

When type is set to self-pay the Patient must be referenced in payor directly. No other entries are allowed.

If type is set to insurance the name of the insurer must be provided in payor.display. Additionally, an optional entry for supplementary insurance (Zusatzversicherung) can be added by providing the name of the insurer in payor.display

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	SΣ	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SΣC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
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: TRxHub Coverage Type ValueSet (required)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	SΣ	1..1	code	Symbol in syntax defined by the system
beneficiary	SΣC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Slices for payor	SΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SΣC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
payor:mainInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
display	SΣ	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
display	SΣ	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:veka.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG
Coverage.payor:selfPayer.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:mainInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:supplementaryInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG

Constraints

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()
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
Slices for identifier	S	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	S	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
system	S	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	S	1..1	code	Symbol in syntax defined by the system
beneficiary	SC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Slices for payor	S	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
display		0..0		Text alternative for the resource
payor:mainInsurance	S	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
reference		0..0		Literal reference, Relative, internal or absolute URL
display	S	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	S	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
reference		0..0		Literal reference, Relative, internal or absolute URL
display	S	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	SΣ	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
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: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SΣC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length 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)
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: TRxHub Coverage Type ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
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	SΣC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
Slices for payor	SΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SΣC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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
payor:mainInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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	SΣ	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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	SΣ	1..1	string	Text alternative for the resource
class		0..*	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.
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		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	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
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	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Coverage.identifier:veka.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:veka.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍4.0.1	FHIR Std.
Coverage.payor:selfPayer.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:selfPayer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor:mainInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:mainInsurance.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor:supplementaryInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:supplementaryInsurance.​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.

Constraints

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()
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	SΣ	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SΣC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
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: TRxHub Coverage Type ValueSet (required)
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	SΣ	1..1	code	Symbol in syntax defined by the system
beneficiary	SΣC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Slices for payor	SΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SΣC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
reference	SΣC	1..1	string	Literal reference, Relative, internal or absolute URL
payor:mainInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
display	SΣ	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
display	SΣ	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier:veka.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG
Coverage.payor:selfPayer.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:mainInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:supplementaryInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG

Constraints

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()
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
Slices for identifier	S	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	S	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
system	S	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	S	1..1	code	Symbol in syntax defined by the system
beneficiary	SC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Slices for payor	S	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
reference	S	1..1	string	Literal reference, Relative, internal or absolute URL
display		0..0		Text alternative for the resource
payor:mainInsurance	S	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
reference		0..0		Literal reference, Relative, internal or absolute URL
display	S	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	S	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
value[x]
system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
code		0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
reference		0..0		Literal reference, Relative, internal or absolute URL
display	S	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG

Constraints

Id	Grade	Path(s)	Description	Expression
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: trxhub-cov-1, trxhub-cov-2, trxhub-cov-3
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system
identifier:veka	SΣ	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
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: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
value	SΣC	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length 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)
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: TRxHub Coverage Type ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	SΣ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
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	SΣC	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
Slices for payor	SΣ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy Slice: Unordered, Closed by value:extension('https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).code
payor:selfPayer	SΣC	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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
payor:mainInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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	SΣ	1..1	string	Text alternative for the resource
payor:supplementaryInsurance	SΣ	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:payorRole	S	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
id		0..1	string	Unique id for inter-element referencing
extension		0..0		Extension Slice: Unordered, Open by value:url
url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
value[x]	S	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
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	SΣ	1..1	string	Text alternative for the resource
class		0..*	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.
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		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	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
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	Status	Usage	ValueSet	Version	Source
Coverage.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Coverage.identifier:veka.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier:veka.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Coverage.type	Base	required	TRxHub Coverage Type ValueSet	📦0.1.0	This IG
Coverage.relationship	Base	extensible	SubscriberPolicyholder Relationship Codes	📍4.0.1	FHIR Std.
Coverage.payor:selfPayer.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:selfPayer.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor:mainInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:mainInsurance.​type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.
Coverage.payor:supplementaryInsurance.​extension:payorRole.​value[x]	Base	required	TRxHub Coverage Payor Role ValueSet	📦0.1.0	This IG
Coverage.payor:supplementaryInsurance.​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.

Constraints

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()
trxhub-cov-1	error	Coverage	If type is self-pay, exactly one payor with role self-pay must exist	type.coding.where(code = 'self-pay').exists() implies (payor.count() = 1 and payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').exists())
trxhub-cov-2	error	Coverage	If type is insurance, a payor with role main-insurance must exist	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'main-insurance').exists()
trxhub-cov-3	error	Coverage	If type is insurance, a payor with role self-pay is not allowed	type.coding.where(code = 'insurance').exists() implies payor.extension.where(url = 'https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension').value.ofType(Coding).where(code = 'self-pay').empty()
trxhub-cov-veka-length	error	Coverage.identifier:veka.value	VEKA number must start with 807560 followed by 14 digits	matches('^807560[0-9]{14}$')
trxhub-inv-patient-ref-only	error	Coverage.beneficiary, Coverage.payor:selfPayer	Reference must point to a Patient resource	reference.exists() implies reference.startsWith('Patient/')

This structure is derived from Coverage

Summary

Mandatory: 4 elements(11 nested mandatory elements)
Must-Support: 20 elements
Fixed: 1 element
Prohibited: 3 elements

Extensions

This structure refers to these extensions:

• https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.identifier (Closed)
• The element 1 is sliced based on the value of Coverage.payor (Closed)