Financial instrument which may be used to reimburse or pay for health care products and services.

Health care programs and insurers are significant payors of health service costs.

The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant.

This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.

The status of the resource instance.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.

The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.

The order of application of coverages is dependent on the types of coverage.

The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer.

The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.

The insurer assigned ID for the Subscriber.

The party who benefits from the insurance coverage., the patient when services are provided.

A unique identifier for a dependent under the coverage.

For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary.

The relationship of beneficiary (patient) to the subscriber.

To determine relationship between the patient and the subscriber.

Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.

The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).

Need to identify the issuer to target for processing and for coordination of benefit processing.

A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan.

Identifies a style or collective The type of coverage issued by the underwriter, classification for which an insurer-specific class tag or number and optional name is provided, for example may be used to identify an employer group. May also be referred to as a Policy class of coverage or Group ID. employer group, Policy, Plan.

A short description for For example the subgroup. Group or Plan number.

A short description for the plan. class.

Identifies a sub-style or sub-collective The order of applicability of this coverage issued by the underwriter, for example relative to other coverages which are currently inforce. Note, there may be used to identify a subset gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of a collection coverages depends upon the episode of benefits provided to employees. care.

Identifies a style or collective The insurer-specific identifier for the insurer-defined network of coverage issues by providers to which the underwriter, for example beneficiary may seek treatment which will be used to identify a class of coverage such as a level covered at the 'in-network' rate, otherwise 'out of deductables or co-payment. network' terms and conditions apply.

Identifies a sub-style or sub-collective A suite of coverage issues by the underwriter, underwrite specific classifiers, for example may be used to identify a subclass class of coverage such as a sub-level of deductables or co-payment. employer group, Policy, Plan.

A short description for the subclass. Types of products or services such as visit, specialist vists, emergency, inpatient care, etc.

The order amount of applicability patient payments for various types of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. services/products, expressed as the specific positioning a percentage of coverages depends upon the episode service/product cost or a fixed amount of care. currency,.

The policy(s) which constitute this insurance coverage.