Coverage - FHIR Resource (stu3)
This Coverage Resource uses the FHIR API standard for access and structure.
Validate an Coverage FHIR Resource (stu3)
Coverage Attributes
AttributeField is listTypeDescription
Description: active | cancelled | draft | entered-in-error
FHIR Version: stu3
Attribute Type : code
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"status": "active"Learn more about the (Coverage) status FHIR attribute
Description: Subscriber to the policy
FHIR Version: stu3
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"subscriber": {
"reference": "Patient/4"
}Learn more about the (Coverage) subscriber FHIR attribute
Description: Identifier for the plan or agreement issuer
FHIR Version: stu3
Attribute Type : Reference
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"payor": [
{
"reference": "Organization/2"
}
]Learn more about the (Coverage) payor FHIR attribute
Description: Insurer network
FHIR Version: stu3
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"network": Learn more about the (Coverage) network FHIR attribute
Description: Beneficiary relationship to the Subscriber
FHIR Version: stu3
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"relationship": {
"coding": [
{
"code": "self"
}
]
}Learn more about the (Coverage) relationship FHIR attribute
Description: The plan instance or sequence counter
FHIR Version: stu3
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"sequence": "9"Learn more about the (Coverage) sequence FHIR attribute
Description: Dependent number
FHIR Version: stu3
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"dependent": "0"Learn more about the (Coverage) dependent FHIR attribute
Description: Type of coverage such as medical or accident
FHIR Version: stu3
Attribute Type : CodeableConcept
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"type": {
"coding": [
{
"code": "EHCPOL",
"system": "http://hl7.org/fhir/v3/ActCode",
"display": "extended healthcare"
}
]
}Learn more about the (Coverage) type FHIR attribute
Description: Coverage start and end dates
FHIR Version: stu3
Attribute Type : Period
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"period": {
"start": "2011-05-23",
"end": "2012-05-23"
}Learn more about the (Coverage) period FHIR attribute
Description: Contract details
FHIR Version: stu3
Attribute Type : Reference
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"contract": Learn more about the (Coverage) contract FHIR attribute
Description: ID assigned to the Subscriber
FHIR Version: stu3
Attribute Type : string
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"subscriberId": Learn more about the (Coverage) subscriberId FHIR attribute
Description: Plan Beneficiary
FHIR Version: stu3
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"beneficiary": {
"reference": "Patient/4"
}Learn more about the (Coverage) beneficiary FHIR attribute
Description: The primary coverage ID
FHIR Version: stu3
Attribute Type : Identifier
Required: N/A
Countability: Array
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"identifier": [
{
"system": "http://benefitsinc.com/certificate",
"value": "12345"
}
]Learn more about the (Coverage) identifier FHIR attribute
Description: Owner of the policy
FHIR Version: stu3
Attribute Type : Reference
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"policyHolder": {
"reference": "http://benefitsinc.com/FHIR/Organization/CBI35"
}Learn more about the (Coverage) policyHolder FHIR attribute
Description: Relative order of the coverage
FHIR Version: stu3
Attribute Type : positiveInt
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"order": Learn more about the (Coverage) order FHIR attribute
Description: Additional coverage classifications
FHIR Version: stu3
Attribute Type : Data Type
Required: N/A
Countability: Singleton
Flags: N/A
Terminology bindings: N/A
Requirements: N/A
Comments: N/A
Example:
"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"
}Learn more about the (Coverage) grouping FHIR attribute
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 them like so:
https://api.1up.health/fhir/stu3/Coverage?query-param=queryvalue| Search Parameter | Field Type | Resource Fields Searched |
|---|---|---|
beneficiary | reference | beneficiary |
class | text | grouping.class |
dependent | text | dependent |
group | text | grouping.group |
identifier | text | identifier |
payor | reference | payor |
plan | text | grouping.plan |
policy-holder | reference | policyHolder |
sequence | text | sequence |
subclass | text | grouping.subClass |
subgroup | text | grouping.subGroup |
subplan | text | grouping.subPlan |
subscriber | reference | subscriber |
type | text | type |
