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
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. Σ This element is included in summaries. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.coding	S This element must be supported. Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor	S This element must be supported. Σ This element is included in summaries.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported. Σ This element is included in summaries.	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	TRxHub Coverage Status ValueSet	📦0.1.0	This IG
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/') or reference.startsWith('urn:uuid:'))

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
Coverage.Slices for identifier	S This element must be supported.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.coding	S This element must be supported.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Coverage.beneficiary	S This element must be supported. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor	S This element must be supported.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported.	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:selfPayer.display		0..0		Text alternative for the resource
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.reference		0..0		Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.reference		0..0		Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported.	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.status	Base	required	TRxHub Coverage Status ValueSet	📦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 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/') or reference.startsWith('urn:uuid:'))

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
Coverage.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.extension		0..*	Extension	Additional content defined by implementations
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:veka.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for identifier.identifier:veka.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:veka.type	Σ This element is included in summaries.	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.
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. Σ This element is included in summaries. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
Coverage.Slices for identifier.identifier:veka.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Coverage.Slices for identifier.identifier:veka.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.id		0..1	string	Unique id for inter-element referencing
Coverage.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding	S This element must be supported. Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.type.coding.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Coverage.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	Σ This element is included in summaries.	0..1	string	ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period	Σ This element is included in summaries.	0..1	Period	Coverage start and end dates
Coverage.Slices for payor	S This element must be supported. Σ This element is included in summaries.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:selfPayer.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:selfPayer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:mainInsurance.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:mainInsurance.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:supplementaryInsurance.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:supplementaryInsurance.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.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	TRxHub Coverage Status ValueSet	📦0.1.0	This IG
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/') or reference.startsWith('urn:uuid:'))

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
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. Σ This element is included in summaries. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.coding	S This element must be supported. Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor	S This element must be supported. Σ This element is included in summaries.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported. Σ This element is included in summaries.	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	TRxHub Coverage Status ValueSet	📦0.1.0	This IG
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/') or reference.startsWith('urn:uuid:'))

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
Coverage.Slices for identifier	S This element must be supported.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length
Coverage.status	S This element must be supported.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.coding	S This element must be supported.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Coverage.beneficiary	S This element must be supported. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor	S This element must be supported.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported.	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:selfPayer.display		0..0		Text alternative for the resource
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.reference		0..0		Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.extension		1..*	Extension	Extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system		0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code		0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.reference		0..0		Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported.	1..1	string	Text alternative for the resource
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Coverage.status	Base	required	TRxHub Coverage Status ValueSet	📦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 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/') or reference.startsWith('urn:uuid:'))

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
Coverage.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Coverage.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Coverage.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Coverage.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Coverage.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
Coverage.contained		0..*	Resource	Contained, inline Resources
Coverage.extension		0..*	Extension	Additional content defined by implementations
Coverage.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Coverage.Slices for identifier	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for identifier.identifier:veka	S This element must be supported. Σ This element is included in summaries.	0..1	Identifier	VEKA (insurance card) number of the patient (20 digits)
Coverage.Slices for identifier.identifier:veka.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for identifier.identifier:veka.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for identifier.identifier:veka.use	?! This element is a modifier element. Σ This element is included in summaries.	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Coverage.Slices for identifier.identifier:veka.type	Σ This element is included in summaries.	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.
Coverage.Slices for identifier.identifier:veka.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	The namespace for the identifier value Fixed Value: urn:oid:2.16.756.5.30.1.123.100.1.1.1
Coverage.Slices for identifier.identifier:veka.value	S This element must be supported. Σ This element is included in summaries. C	1..1	string	The value that is unique Constraints: trxhub-cov-veka-length Example General: 123456
Coverage.Slices for identifier.identifier:veka.period	Σ This element is included in summaries.	0..1	Period	Time period when id is/was valid for use
Coverage.Slices for identifier.identifier:veka.assigner	Σ This element is included in summaries.	0..1	Reference(Organization)	Organization that issued id (may be just text)
Coverage.status	?! This element is a modifier element. S This element must be supported. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: TRxHub Coverage Status ValueSet (required)
Coverage.type	S This element must be supported. Σ This element is included in summaries.	1..1	CodeableConcept	Coverage category such as medical or accident Binding: TRxHub Coverage Type ValueSet (required)
Coverage.type.id		0..1	string	Unique id for inter-element referencing
Coverage.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding	S This element must be supported. Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Coverage.type.coding.id		0..1	string	Unique id for inter-element referencing
Coverage.type.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.type.coding.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-type
Coverage.type.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.type.coding.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Coverage.type.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.type.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.type.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Coverage.policyHolder	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
Coverage.subscriber	Σ This element is included in summaries.	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
Coverage.subscriberId	Σ This element is included in summaries.	0..1	string	ID assigned to the subscriber
Coverage.beneficiary	S This element must be supported. Σ This element is included in summaries. C	1..1	Reference(Patient)	Plan beneficiary Constraints: trxhub-inv-patient-ref-only
Coverage.dependent	Σ This element is included in summaries.	0..1	string	Dependent number
Coverage.relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period	Σ This element is included in summaries.	0..1	Period	Coverage start and end dates
Coverage.Slices for payor	S This element must be supported. Σ This element is included in summaries.	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 Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer	S This element must be supported. Σ This element is included in summaries. C	0..1	Reference(Patient)	Reference to patient when type is self-pay Constraints: trxhub-inv-patient-ref-only
Coverage.Slices for payor.payor:selfPayer.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:selfPayer.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: self-pay
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:selfPayer.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:selfPayer.reference	S This element must be supported. Σ This element is included in summaries. C	1..1	string	Literal reference, Relative, internal or absolute URL
Coverage.Slices for payor.payor:selfPayer.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:selfPayer.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:mainInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the main insurance (Grundversicherung)
Coverage.Slices for payor.payor:mainInsurance.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:mainInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: main-insurance
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:mainInsurance.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:mainInsurance.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:mainInsurance.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:mainInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.Slices for payor.payor:supplementaryInsurance	S This element must be supported. Σ This element is included in summaries.	0..1	Reference(Organization | Patient | RelatedPerson)	Display name of the supplementary insurance (Zusatzversicherung)
Coverage.Slices for payor.payor:supplementaryInsurance.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension				Content/Rules for all slices
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole	S This element must be supported.	1..1	(Complex)	TRxHub Coverage Payor Role URL: https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.extension		0..0		Extension Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.url		1..1	uri	"https://trxhub.mediservice.ch/fhir/StructureDefinition/trxhub-coverage-payor-role-extension"
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x]	S This element must be supported.	1..1	Coding	Value of extension Binding: TRxHub Coverage Payor Role ValueSet (required)
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].id		0..1	string	Unique id for inter-element referencing
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].system	Σ This element is included in summaries.	0..1	uri	Identity of the terminology system Required Pattern: https://trxhub.mediservice.ch/fhir/CodeSystem/trxhub-coverage-payor-role
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].code	Σ This element is included in summaries.	0..1	code	Symbol in syntax defined by the system Required Pattern: supplementary-insurance
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Coverage.Slices for payor.payor:supplementaryInsurance.Slices for extension.extension:payorRole.value[x].userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Coverage.Slices for payor.payor:supplementaryInsurance.type	Σ This element is included in summaries.	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).
Coverage.Slices for payor.payor:supplementaryInsurance.identifier	Σ This element is included in summaries.	0..1	Identifier	Logical reference, when literal reference is not known
Coverage.Slices for payor.payor:supplementaryInsurance.display	S This element must be supported. Σ This element is included in summaries.	1..1	string	Text alternative for the resource
Coverage.class		0..*	BackboneElement	Additional coverage classifications
Coverage.class.id		0..1	string	Unique id for inter-element referencing
Coverage.class.extension		0..*	Extension	Additional content defined by implementations
Coverage.class.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.class.type	Σ This element is included in summaries.	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value	Σ This element is included in summaries.	1..1	string	Value associated with the type
Coverage.class.name	Σ This element is included in summaries.	0..1	string	Human readable description of the type and value
Coverage.order	Σ This element is included in summaries.	0..1	positiveInt	Relative order of the coverage
Coverage.network	Σ This element is included in summaries.	0..1	string	Insurer network
Coverage.costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
Coverage.costToBeneficiary.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type	Σ This element is included in summaries.	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x]	Σ This element is included in summaries.	1..1		The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity			Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney			Money
Coverage.costToBeneficiary.exception		0..*	BackboneElement	Exceptions for patient payments
Coverage.costToBeneficiary.exception.id		0..1	string	Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension		0..*	Extension	Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type	Σ This element is included in summaries.	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period	Σ This element is included in summaries.	0..1	Period	The effective period of the exception
Coverage.subrogation		0..1	boolean	Reimbursement to insurer
Coverage.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	TRxHub Coverage Status ValueSet	📦0.1.0	This IG
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/') or reference.startsWith('urn:uuid:'))

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)