This page is part of the HL7 Belgium FHIR Implementation Guide - MyCareNet profiles (v2.1.1: Release) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.2. For a full list of available versions, see the Directory of published versions

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Resource Profile: MyCareNet Coverage BE profile

Coverage profile for use in the different MyCareNet flows

Usages:

• This Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement Constraints: BeInvCT1CT2
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
beneficiary	SΣ	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
payor	SΣ	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
value	SΣ	1..1	string	Value associated with the type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')
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	Coverage.implicitRules, Coverage.modifierExtension, Coverage.status, Coverage.type, Coverage.type.coding, Coverage.type.coding.system, Coverage.type.coding.code, Coverage.beneficiary, Coverage.payor, Coverage.class, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.type.coding, Coverage.class.type.coding.system, Coverage.class.type.coding.code, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.modifierExtension, Coverage.class.modifierExtension, Coverage.class.value.extension, Coverage.class.value.extension:system	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement
id	S	1..1	id	Logical id of this artifact
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	Coverage category such as medical or accident
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
beneficiary	S	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
payor	S	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan'
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
value	S	1..1	string	Value associated with the type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement Constraints: BeInvCT1CT2
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system Constraints: ext-1
value		0..1	string	Primitive value for string Max Length:1048576
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')
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	Coverage.meta, Coverage.implicitRules, Coverage.language, Coverage.text, Coverage.extension, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.type.extension, Coverage.type.coding, Coverage.type.coding.extension, Coverage.type.coding.system, Coverage.type.coding.version, Coverage.type.coding.code, Coverage.type.coding.display, Coverage.type.coding.userSelected, Coverage.type.text, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, Coverage.class, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.type.extension, Coverage.class.type.coding, Coverage.class.type.coding.extension, Coverage.class.type.coding.system, Coverage.class.type.coding.version, Coverage.class.type.coding.code, Coverage.class.type.coding.display, Coverage.class.type.coding.userSelected, Coverage.class.type.text, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:system, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.value[x], Coverage.costToBeneficiary.exception, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension, Coverage.costToBeneficiary.exception.type, Coverage.costToBeneficiary.exception.period, Coverage.subrogation, Coverage.contract	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.extension, Coverage.modifierExtension, Coverage.type.extension, Coverage.type.coding.extension, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type.extension, Coverage.class.type.coding.extension, Coverage.class.value.extension, Coverage.class.value.extension:system, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 8 elements
Must-Support: 15 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient|2.1.2)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization|2.1.2)

Extensions

This structure refers to these extensions:

• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system|2.1.1

Maturity: 1

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement Constraints: BeInvCT1CT2
id	SΣ	1..1	id	Logical id of this artifact
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
beneficiary	SΣ	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
payor	SΣ	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
coding	SΣ	1..1	Coding	Code defined by a terminology system
system	SΣ	1..1	uri	Identity of the terminology system
code	SΣ	1..1	code	Symbol in syntax defined by the system
value	SΣ	1..1	string	Value associated with the type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system Constraints: ext-1
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')
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	Coverage.implicitRules, Coverage.modifierExtension, Coverage.status, Coverage.type, Coverage.type.coding, Coverage.type.coding.system, Coverage.type.coding.code, Coverage.beneficiary, Coverage.payor, Coverage.class, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.type.coding, Coverage.class.type.coding.system, Coverage.class.type.coding.code, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.modifierExtension, Coverage.class.modifierExtension, Coverage.class.value.extension, Coverage.class.value.extension:system	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement
id	S	1..1	id	Logical id of this artifact
status	S	1..1	code	active | cancelled | draft | entered-in-error
type	S	1..1	CodeableConcept	Coverage category such as medical or accident
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
beneficiary	S	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
payor	S	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
type	S	1..1	CodeableConcept	Type of class such as 'group' or 'plan'
coding	S	1..1	Coding	Code defined by a terminology system
system	S	1..1	uri	Identity of the terminology system
code	S	1..1	code	Symbol in syntax defined by the system
value	S	1..1	string	Value associated with the type
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage(4.0.1)	Insurance or medical plan or a payment agreement Constraints: BeInvCT1CT2
id	SΣ	1..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored Constraints: ext-1
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
status	?!SΣ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	SΣ	1..1	CodeableConcept	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(BePatient(2.1.2))	Plan beneficiary
dependent	Σ	0..1	string	Dependent number
relationship		0..1	CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Coverage start and end dates
payor	SΣ	1..1	Reference(BeOrganization(2.1.2))	Issuer of the policy
class	S	2..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	SΣ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
coding	SΣ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url Constraints: ext-1
system	SΣ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
value	SΣ	1..1	string	Value associated with the type
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Constraints: ext-1
extension:system	S	0..1	uri	Extension URL: https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system Constraints: ext-1
value		0..1	string	Primitive value for string Max Length:1048576
name	Σ	0..1	string	Human readable description of the type and value
order	Σ	0..1	positiveInt	Relative order of the coverage
network	Σ	0..1	string	Insurer network
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Constraints: ext-1
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized Constraints: ext-1
type	Σ	1..1	CodeableConcept	Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	The effective period of the exception
subrogation		0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages|4.0.1 From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type|4.0.1 From the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1 From the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1 From the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1 From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BeInvCT1CT2	error	Coverage	Coverage.class SHALL contain at least a CT1 and a CT2 value : Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').empty().not() and Coverage.class.value.extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value is Uri).where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').empty().not() and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-1').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-1') and Coverage.class.value.where(extension('https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system').where(value = 'https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/be-cs-holder-code-2').exists()).memberOf('https://www.ehealth.fgov.be/standards/fhir/mycarenet/ValueSet/be-vs-holder-code-2')
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	Coverage.meta, Coverage.implicitRules, Coverage.language, Coverage.text, Coverage.extension, Coverage.modifierExtension, Coverage.identifier, Coverage.status, Coverage.type, Coverage.type.extension, Coverage.type.coding, Coverage.type.coding.extension, Coverage.type.coding.system, Coverage.type.coding.version, Coverage.type.coding.code, Coverage.type.coding.display, Coverage.type.coding.userSelected, Coverage.type.text, Coverage.policyHolder, Coverage.subscriber, Coverage.subscriberId, Coverage.beneficiary, Coverage.dependent, Coverage.relationship, Coverage.period, Coverage.payor, Coverage.class, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type, Coverage.class.type.extension, Coverage.class.type.coding, Coverage.class.type.coding.extension, Coverage.class.type.coding.system, Coverage.class.type.coding.version, Coverage.class.type.coding.code, Coverage.class.type.coding.display, Coverage.class.type.coding.userSelected, Coverage.class.type.text, Coverage.class.value, Coverage.class.value.extension, Coverage.class.value.extension:system, Coverage.class.name, Coverage.order, Coverage.network, Coverage.costToBeneficiary, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.type, Coverage.costToBeneficiary.value[x], Coverage.costToBeneficiary.exception, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension, Coverage.costToBeneficiary.exception.type, Coverage.costToBeneficiary.exception.period, Coverage.subrogation, Coverage.contract	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.extension, Coverage.modifierExtension, Coverage.type.extension, Coverage.type.coding.extension, Coverage.class.extension, Coverage.class.modifierExtension, Coverage.class.type.extension, Coverage.class.type.coding.extension, Coverage.class.value.extension, Coverage.class.value.extension:system, Coverage.costToBeneficiary.extension, Coverage.costToBeneficiary.modifierExtension, Coverage.costToBeneficiary.exception.extension, Coverage.costToBeneficiary.exception.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 8 elements
Must-Support: 15 elements

Structures

This structure refers to these other structures:

• BePatient (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient|2.1.2)
• BeOrganization (https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization|2.1.2)

Extensions

This structure refers to these extensions:

• https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-ext-system|2.1.1

Maturity: 1

Other representations of profile: CSV, Excel, Schematron