This page is part of the FHIR Specification (v0.0.82: DSTU 1). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2 Content Examples Detailed Descriptions Mappings Profiles 7.3.4 Resource Coverage - Detailed Descriptions Detailed Descriptions for the elements in the Coverage resource. Coverage Definition Financial instrument which may be used to pay for or reimburse for health care products and services. Control 1..1 Requirements Health care programs and insurers are significant payors of health service costs. Coverage.issuer Definition The program or plan underwriter or payor. Control 0..1 Type Reference ( Organization ) Requirements Need to identify the issuer to target for processing and for coordination of benefit processing. Summary true Coverage.bin Definition Business Identification Number (BIN number) used to identify the routing of eclaims if the insurer themselves don't have a BIN number for all of their business. Control 0..1 Type Identifier Coverage.period Definition 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. Control 0..1 Type Period Summary true Coverage.type Definition The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health. Control 0..1 Binding CoverageType: The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) ( Example ) Type Coding Requirements The order of application of coverages is dependent on the types of coverage. Summary true Coverage.subscriberId Definition The id issued to the subscriber. Control 0..1 Type Identifier Summary true Coverage.identifier Definition The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Subscriber Id, Certificate number or Personal Health Number or Case ID. Note This is a business identifer, not a resource identifier (see discussion ) Control 0..* Type Identifier Requirements This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below. Summary true Coverage.group Definition Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID. Control 0..1 Type string Summary true Coverage.plan Definition Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID. Control 0..1 Type string Summary true Coverage.subPlan Definition Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a specific employer group within a class of employers. May be referred to as a Section or Division ID. Control 0..1 Type string Summary true Coverage.dependent Definition A unique identifier for a dependent under the coverage. Control 0..1 Type integer Requirements For some coverage a single identifier is issued to the PolicyHolder and dependent number issues to each to each of their dependents to track and manage the plan. Summary true Coverage.sequence Definition An optional counter for a particular instance of the identified coverage which increments upon each renewal. Control 0..1 Type integer Requirements Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. Summary true Coverage.subscriber Definition The party who 'owns' the insurance contractual relationship to the policy or to whom the benefit of the policy is due. Control 0..1 Type Reference ( Patient ) Is Modifier true To Do D01 through D09. Coverage.network Definition The identifier for a community of providers. Control 0..1 Type Identifier Summary true Coverage.contract Definition The policy(s) which constitute this insurance coverage. Control 0..* Type Reference ( Contract ) To Do D01 through D09. © HL7.org 2011+. FHIR DSTU (v0.4.0-4902) generated on Fri, Mar 27, 2015 00:19+1100. Links: What's a DSTU? | Version History | Specification Map | Compare to DSTU1 | | Propose a change