Coverage - FHIR Resource (stu3)


Resource Attributes

AttributeField is listTypeDescription
beneficiaryfalseReference Plan Beneficiary
contracttrueReference Contract details
dependentfalsestring Dependent number
groupingfalseData Type Additional coverage classifications
identifiertrueIdentifier The primary coverage ID
networkfalsestring Insurer network
orderfalsepositiveInt Relative order of the coverage
payortrueReference Identifier for the plan or agreement issuer
periodfalsePeriod Coverage start and end dates
policyHolderfalseReference Owner of the policy
relationshipfalseCodeableConcept Beneficiary relationship to the Subscriber
sequencefalsestring The plan instance or sequence counter
statusfalsecode active | cancelled | draft | entered-in-error
subscriberfalseReference Subscriber to the policy
subscriberIdfalsestring ID assigned to the Subscriber
typefalseCodeableConcept Type of coverage such as medical or accident

Coverage Example

{
  "status": "active",
  "beneficiary": {
    "reference": "Patient/4"
  },
  "payor": [
    {
      "reference": "Organization/2"
    }
  ],
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "sequence": "9",
  "resourceType": "Coverage",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "period": {
    "start": "2011-05-23",
    "end": "2012-05-23"
  },
  "subscriber": {
    "reference": "Patient/4"
  },
  "dependent": "0",
  "identifier": [
    {
      "system": "http://benefitsinc.com/certificate",
      "value": "12345"
    }
  ],
  "type": {
    "coding": [
      {
        "code": "EHCPOL",
        "system": "http://hl7.org/fhir/v3/ActCode",
        "display": "extended healthcare"
      }
    ]
  },
  "id": "9876B1",
  "policyHolder": {
    "reference": "http://benefitsinc.com/FHIR/Organization/CBI35"
  },
  "grouping": {
    "group": "CBI35",
    "subPlanDisplay": "Includes afterlife benefits",
    "subClassDisplay": "Low deductable, max $20 copay",
    "groupDisplay": "Corporate Baker's Inc. Local #35",
    "subClass": "Tier2",
    "subPlan": "P7",
    "plan": "B37FC",
    "subGroupDisplay": "Trainee Part-time Benefits",
    "planDisplay": "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC",
    "class": "SILVER",
    "classDisplay": "Silver: Family Plan spouse only",
    "subGroup": "123"
  }
}

Coverage Structure


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


 

Coverage Search Parameters

The following search parameters can be used to query Coverage resources. Just submit the like so:

https://api.1up.health/fhir/stu3/Coverage?query-param=queryvalue
Search ParameterField TypeResource Fields Searched
beneficiaryreferencebeneficiary
classtextgrouping.class
dependenttextdependent
grouptextgrouping.group
identifiertextidentifier
payorreferencepayor
plantextgrouping.plan
policy-holderreferencepolicyHolder
sequencetextsequence
subclasstextgrouping.subClass
subgrouptextgrouping.subGroup
subplantextgrouping.subPlan
subscriberreferencesubscriber
typetexttype