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.

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 insurance the name of the insurer must be provided in payor.display. If type is set to self-pay the Patient must be referenced in payor directly.

• 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
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for the coverage
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique 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	Σ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	Σ	1..1	code	Symbol in syntax defined by the system
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary
payor	Σ	1..1	Reference(Patient)	Issuer of the policy
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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

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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

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
identifier	S	0..*	Identifier	Business Identifier for the coverage
system		1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required)
value		1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error
type		1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code		1..1	code	Symbol in syntax defined by the system
payor		1..1	Reference(Patient)	Issuer of the policy
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

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
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
identifier	SΣ	0..*	Identifier	Business Identifier for the coverage
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	Σ	1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	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	Σ	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	Σ	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	Σ	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	Σ	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	Σ	1..1	Reference(Patient)	Plan beneficiary
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
payor	Σ	1..1	Reference(Patient)	Issuer of the policy
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.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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.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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

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
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for the coverage
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique 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	Σ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code	Σ	1..1	code	Symbol in syntax defined by the system
beneficiary	Σ	1..1	Reference(Patient)	Plan beneficiary
payor	Σ	1..1	Reference(Patient)	Issuer of the policy
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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

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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

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
identifier	S	0..*	Identifier	Business Identifier for the coverage
system		1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required)
value		1..1	string	The value that is unique
status	S	1..1	code	active | cancelled | draft | entered-in-error
type		1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
coding		1..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
code		1..1	code	Symbol in syntax defined by the system
payor		1..1	Reference(Patient)	Issuer of the policy
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

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
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
identifier	SΣ	0..*	Identifier	Business Identifier for the coverage
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	Σ	1..1	uri	The namespace for the identifier value Binding: TRxHub Coverage Identifier Systems (required) Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	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	Σ	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	Σ	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	Σ	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	Σ	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	Σ	1..1	Reference(Patient)	Plan beneficiary
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
payor	Σ	1..1	Reference(Patient)	Issuer of the policy
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.​use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Coverage.identifier.​type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Coverage.identifier.​system	Base	required	TRxHub Coverage Identifier Systems	📦0.1.0	This IG
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.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 insurance, payor.display must exist; if self-pay, payor.reference must exist	(type.coding.code = 'insurance' implies payor.display.exists()) and (type.coding.code = 'self-pay' implies payor.reference.exists())

This structure is derived from Coverage

Summary

Mandatory: 4 elements(2 nested mandatory elements)
Must-Support: 2 elements