New Zealand NES IG
1.4.6 - Release

New Zealand NES IG - Local Development build (v1.4.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: NesEntitlement - Detailed Descriptions

Active as of 2024-09-04

Definitions for the NesEntitlement resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Coverage
InvariantsCOVERAGE-STATUS-ALLOWED-CODES: draft status is not allowed (Coverage.status.all(matches('draft').not()))
COVERAGE-URL-ALLOWED-CHARS: character restrictions for URLs (Coverage.descendants().url.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
COVERAGE-SYSTEM-LENGTH: System URLs must be less than 1024 characters (Coverage.descendants().system.all(length()<1024))
COVERAGE-SYSTEM-ALLOWED-CHARS: character restrictions for system url (Coverage.descendants().system.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
COVERAGE-CODEABLE-CONCEPT-TEXT-LENGTH: valueCodeableConcept.text must be less than 1024 characters (Coverage.descendants().valueCodeableConcept.text.all(length()<1024))
COVERAGE-CODEABLE-CONCEPT-TEXT-ALLOWED-CHARS: character restrictions for valueCodeableConcept.text (Coverage.descendants().valueCodeableConcept.text.all(matches('^([-a-zA-Z0-9\' \t\r\n.\/,])*$')))
2. Coverage.id
ShortLogical id of this artifact (The Entitlement.id)
4. Coverage.implicitRules
Control0..0
6. Coverage.language
Control0..0
8. Coverage.contained
SlicingThis element introduces a set of slices on Coverage.contained. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
  • 10. Coverage.contained:beneficiary
    Slice Namebeneficiary
    Control0..1
    TypePatient(NES Patient)
    12. Coverage.identifier
    Definition

    A unique identifier assigned to this Entitlement (the card number).

    ShortBusiness Identifier for the Entitlement
    NoteThis is a business identifier, not a resource identifier (see discussion)
    14. Coverage.identifier.id
    Control0..0
    16. Coverage.identifier.extension
    Control0..0
    18. Coverage.identifier.use
    Fixed Valueofficial
    20. Coverage.identifier.type
    Control0..0
    22. Coverage.identifier.system
    BindingThe codes SHALL be taken from NES Entitlement System Identifiers
    (required to https://nzhts.digital.health.nz/fhir/ValueSet/nes-entitlement-identifier-code)
    24. Coverage.identifier.period
    Control0..0
    26. Coverage.identifier.assigner
    Control0..0
    28. Coverage.status
    Definition

    The status of entitlement, derived from the start and end dates. Cancelled = ended entitlements.

    Shortactive | cancelled
    30. Coverage.type
    Definition

    The type of the Entitlement for example community services card (CSC) or high user health card (HUHC).

    ShortEntitlement type such as CSC or HUHC.
    BindingThe codes SHALL be taken from CoverageType (1.1.0)
    (required to https://nzhts.digital.health.nz/fhir/ValueSet/coverage-type-code|1.1.0)
    32. Coverage.policyHolder
    Control0..0
    34. Coverage.subscriber
    Control0..0
    36. Coverage.subscriberId
    Control0..0
    38. Coverage.beneficiary
    Definition

    The NHI number of the person who benefits from the entitlement

    ShortThe Health service user's NHI.
    TypeReference(NES Patient)
    40. Coverage.dependent
    Control0..0
    42. Coverage.relationship
    Definition

    An attribute used to identify if this entitlement is dependent on another CSC entitlement. Child for CSC-dep

    ShortUsed to identify a CSC dependent
    44. Coverage.period
    Definition

    Time period of the entitlement. Period Start = Entitlement start date. Period end = Entitlement expiry date (active entitlements) or Entitlement end date (ended entitlements).

    ShortEntitlement Start and Expiry or End date
    46. Coverage.payor
    Definition

    The HPI Org Id for the organisation approving a Patient Entitlement.

    ShortOrganisation approving the entitlement.
    48. Coverage.class
    Control0..0
    50. Coverage.order
    Control0..0
    52. Coverage.network
    Control0..0
    54. Coverage.costToBeneficiary
    Control0..0
    56. Coverage.subrogation
    Control0..0
    58. Coverage.contract
    Control0..0

    Guidance on how to interpret the contents of this table can be found here

    0. Coverage
    Definition

    Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

    ShortInsurance or medical plan or a payment agreement
    Comments

    The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    COVERAGE-STATUS-ALLOWED-CODES: draft status is not allowed (Coverage.status.all(matches('draft').not()))
    COVERAGE-URL-ALLOWED-CHARS: character restrictions for URLs (Coverage.descendants().url.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
    COVERAGE-SYSTEM-LENGTH: System URLs must be less than 1024 characters (Coverage.descendants().system.all(length()<1024))
    COVERAGE-SYSTEM-ALLOWED-CHARS: character restrictions for system url (Coverage.descendants().system.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
    COVERAGE-CODEABLE-CONCEPT-TEXT-LENGTH: valueCodeableConcept.text must be less than 1024 characters (Coverage.descendants().valueCodeableConcept.text.all(length()<1024))
    COVERAGE-CODEABLE-CONCEPT-TEXT-ALLOWED-CHARS: character restrictions for valueCodeableConcept.text (Coverage.descendants().valueCodeableConcept.text.all(matches('^([-a-zA-Z0-9\' \t\r\n.\/,])*$')))
    2. Coverage.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact (The Entitlement.id)
    Comments

    The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

    Control0..1
    Typeidstring
    Is Modifierfalse
    Summarytrue
    4. Coverage.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..01
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. Coverage.language
    Definition

    The base language in which the resource is written.

    ShortLanguage of the resource content
    Comments

    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

    Control0..01
    BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
    (preferred to http://hl7.org/fhir/ValueSet/languages)

    A human language.

    Additional BindingsPurpose
    AllLanguagesMax Binding
    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Coverage.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

    ShortContained, inline Resources
    Comments

    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

    Control0..*
    TypeResource
    Is Modifierfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    SlicingThis element introduces a set of slices on Coverage.contained. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 10. Coverage.contained:beneficiary
      Slice Namebeneficiary
      Definition

      Demographics and other administrative information about an individual or animal receiving care or other health-related services.


      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortInformation about an individual or animal receiving health care servicesContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..1*
      TypePatientResource(NES Patient)
      Is Modifierfalse
      Summaryfalse
      Alternate NamesSubjectOfCare Client Resident, inline resources, anonymous resources, contained resources
      12. Coverage.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      14. Coverage.identifier
      Definition

      A unique identifier assigned to this Entitlement (the card number).


      A unique identifier assigned to this coverage.

      ShortBusiness Identifier for the EntitlementBusiness Identifier for the coverage
      Comments

      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 concatenation of the Coverage.SubscriberID and the Coverage.dependant.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows coverages to be distinguished and referenced.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. Coverage.identifier.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..01
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      18. Coverage.identifier.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Coverage.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 20. Coverage.identifier.use
        Definition

        The purpose of this identifier.

        Shortusual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control0..1
        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Fixed Valueofficial
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Coverage.identifier.type
        Definition

        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

        ShortDescription of identifier
        Comments

        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

        Control0..01
        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type
        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows users to make use of identifiers when the identifier system is not known.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Coverage.identifier.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Identifier.system is always case sensitive.

        Control0..1
        BindingThe codes SHALL be taken from For codes, see NES Entitlement System Identifiers
        (required to https://nzhts.digital.health.nz/fhir/ValueSet/nes-entitlement-identifier-code)
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Coverage.identifier.period
        Definition

        Time period during which identifier is/was valid for use.

        ShortTime period when id is/was valid for use
        Control0..01
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Coverage.identifier.assigner
        Definition

        Organization that issued/manages the identifier.

        ShortOrganization that issued id (may be just text)
        Comments

        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

        Control0..01
        TypeReference(Organization)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Coverage.status
        Definition

        The status of entitlement, derived from the start and end dates. Cancelled = ended entitlements.


        The status of the resource instance.

        Shortactive | cancelledactive | cancelled | draft | entered-in-error
        Comments

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

        Control1..1
        BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

        A code specifying the state of the resource instance.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Coverage.type
        Definition

        The type of the Entitlement for example community services card (CSC) or high user health card (HUHC).


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

        ShortEntitlement type such as CSC or HUHC.Coverage category such as medical or accident
        Control0..1
        BindingThe codes SHALL be taken from The codes SHOULD be taken from CoverageType (1.1.0)http://hl7.org/fhir/ValueSet/coverage-type
        (required to https://nzhts.digital.health.nz/fhir/ValueSet/coverage-type-code|1.1.0)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Coverage.policyHolder
        Definition

        The party who 'owns' the insurance policy.

        ShortOwner of the policy
        Comments

        For example: may be an individual, corporation or the subscriber's employer.

        Control0..01
        TypeReference(Patient, RelatedPerson, Organization)
        Is Modifierfalse
        Summarytrue
        Requirements

        This provides employer information in the case of Worker's Compensation and other policies.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Coverage.subscriber
        Definition

        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.

        ShortSubscriber to the policy
        Comments

        May be self or a parent in the case of dependants.

        Control0..01
        TypeReference(Patient, RelatedPerson)
        Is Modifierfalse
        Summarytrue
        Requirements

        This is the party who is entitled to the benfits under the policy.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Coverage.subscriberId
        Definition

        The insurer assigned ID for the Subscriber.

        ShortID assigned to the subscriber
        Control0..01
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        The insurer requires this identifier on correspondance and claims (digital and otherwise).

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Coverage.beneficiary
        Definition

        The NHI number of the person who benefits from the entitlement


        The party who benefits from the insurance coverage; the patient when products and/or services are provided.

        ShortThe Health service user's NHI.Plan beneficiary
        Control1..1
        TypeReference(NES Patient, Patient)
        Is Modifierfalse
        Summarytrue
        Requirements

        This is the party who receives treatment for which the costs are reimbursed under the coverage.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Coverage.dependent
        Definition

        A unique identifier for a dependent under the coverage.

        ShortDependent number
        Comments

        Periodically the member number is constructed from the subscriberId and the dependant number.

        Control0..01
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Coverage.relationship
        Definition

        An attribute used to identify if this entitlement is dependent on another CSC entitlement. Child for CSC-dep


        The relationship of beneficiary (patient) to the subscriber.

        ShortUsed to identify a CSC dependentBeneficiary relationship to the subscriber
        Comments

        Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship
        (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship)

        The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        To determine relationship between the patient and the subscriber to determine coordination of benefits.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Coverage.period
        Definition

        Time period of the entitlement. Period Start = Entitlement start date. Period end = Entitlement expiry date (active entitlements) or Entitlement end date (ended entitlements).


        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.

        ShortEntitlement Start and Expiry or End dateCoverage start and end dates
        Control0..1
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Requirements

        Some insurers require the submission of the coverage term.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Coverage.payor
        Definition

        The HPI Org Id for the organisation approving a Patient Entitlement.


        The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

        ShortOrganisation approving the entitlement.Issuer of the policy
        Comments

        May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.

        Control1..*
        TypeReference(Organization, Patient, RelatedPerson)
        Is Modifierfalse
        Summarytrue
        Requirements

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

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Coverage.class
        Definition

        A suite of underwriter specific classifiers.

        ShortAdditional coverage classifications
        Comments

        For example may be used to identify a class of coverage or employer group, Policy, Plan.

        Control0..0*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        The codes provided on the health card which identify or confirm the specific policy for the insurer.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        55. Coverage.order
        Definition

        The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.

        ShortRelative order of the coverage
        Control0..01
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Used in managing the coordination of benefits.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        57. Coverage.network
        Definition

        The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.

        ShortInsurer network
        Control0..01
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Used in referral for treatment and in claims processing.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        59. Coverage.costToBeneficiary
        Definition

        A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.

        ShortPatient payments for services/products
        Comments

        For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.

        Control0..0*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        Required by providers to manage financial transaction with the patient.

        Alternate NamesCoPay, Deductible, Exceptions
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        63. Coverage.subrogation
        Definition

        When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.

        ShortReimbursement to insurer
        Comments

        Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.

        Control0..01
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        See definition for when to be used.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        65. Coverage.contract
        Definition

        The policy(s) which constitute this insurance coverage.

        ShortContract details
        Control0..0*
        TypeReference(Contract)
        Is Modifierfalse
        Summaryfalse
        Requirements

        To reference the legally binding contract between the policy holder and the insurer.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

        Guidance on how to interpret the contents of this table can be found here

        0. Coverage
        Definition

        Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

        ShortInsurance or medical plan or a payment agreement
        Comments

        The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.

        Control0..*
        Is Modifierfalse
        Summaryfalse
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        COVERAGE-STATUS-ALLOWED-CODES: draft status is not allowed (Coverage.status.all(matches('draft').not()))
        COVERAGE-URL-ALLOWED-CHARS: character restrictions for URLs (Coverage.descendants().url.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
        COVERAGE-SYSTEM-LENGTH: System URLs must be less than 1024 characters (Coverage.descendants().system.all(length()<1024))
        COVERAGE-SYSTEM-ALLOWED-CHARS: character restrictions for system url (Coverage.descendants().system.all(matches('^[-a-zA-Z0-9@:%._~#=?&\/]*$')))
        COVERAGE-CODEABLE-CONCEPT-TEXT-LENGTH: valueCodeableConcept.text must be less than 1024 characters (Coverage.descendants().valueCodeableConcept.text.all(length()<1024))
        COVERAGE-CODEABLE-CONCEPT-TEXT-ALLOWED-CHARS: character restrictions for valueCodeableConcept.text (Coverage.descendants().valueCodeableConcept.text.all(matches('^([-a-zA-Z0-9\' \t\r\n.\/,])*$')))
        2. Coverage.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        ShortLogical id of this artifact (The Entitlement.id)
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control0..1
        Typeid
        Is Modifierfalse
        Summarytrue
        4. Coverage.meta
        Definition

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        ShortMetadata about the resource
        Control0..1
        TypeMeta
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. Coverage.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..0
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. Coverage.language
        Definition

        The base language in which the resource is written.

        ShortLanguage of the resource content
        Comments

        Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

        Control0..0
        BindingThe codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages)

        A human language.

        Additional BindingsPurpose
        AllLanguagesMax Binding
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. Coverage.text
        Definition

        A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

        ShortText summary of the resource, for human interpretation
        Comments

        Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

        Control0..1
        TypeNarrative
        Is Modifierfalse
        Summaryfalse
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Coverage.contained
        Definition

        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

        ShortContained, inline Resources
        Comments

        This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

        Control0..*
        TypeResource
        Is Modifierfalse
        Summaryfalse
        Alternate Namesinline resources, anonymous resources, contained resources
        SlicingThis element introduces a set of slices on Coverage.contained. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 14. Coverage.contained:beneficiary
          Slice Namebeneficiary
          Definition

          Demographics and other administrative information about an individual or animal receiving care or other health-related services.

          ShortInformation about an individual or animal receiving health care services
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

          Control0..1
          TypePatient(NES Patient)
          Is Modifierfalse
          Summaryfalse
          Alternate NamesSubjectOfCare Client Resident
          16. Coverage.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          18. Coverage.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summaryfalse
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          20. Coverage.identifier
          Definition

          A unique identifier assigned to this Entitlement (the card number).

          ShortBusiness Identifier for the Entitlement
          Comments

          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 concatenation of the Coverage.SubscriberID and the Coverage.dependant.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows coverages to be distinguished and referenced.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Coverage.identifier.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..0
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          24. Coverage.identifier.extension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Coverage.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 26. Coverage.identifier.use
            Definition

            The purpose of this identifier.

            Shortusual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control0..1
            BindingThe codes SHALL be taken from IdentifierUse
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Typecode
            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Fixed Valueofficial
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. Coverage.identifier.type
            Definition

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            ShortDescription of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control0..0
            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. Coverage.identifier.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            ShortThe namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control0..1
            BindingThe codes SHALL be taken from NES Entitlement System Identifiers
            (required to https://nzhts.digital.health.nz/fhir/ValueSet/nes-entitlement-identifier-code)
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Coverage.identifier.value
            Definition

            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

            ShortThe value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Example<br/><b>General</b>:123456
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. Coverage.identifier.period
            Definition

            Time period during which identifier is/was valid for use.

            ShortTime period when id is/was valid for use
            Control0..0
            TypePeriod
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. Coverage.identifier.assigner
            Definition

            Organization that issued/manages the identifier.

            ShortOrganization that issued id (may be just text)
            Comments

            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

            Control0..0
            TypeReference(Organization)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. Coverage.status
            Definition

            The status of entitlement, derived from the start and end dates. Cancelled = ended entitlements.

            Shortactive | cancelled
            Comments

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

            Control1..1
            BindingThe codes SHALL be taken from FinancialResourceStatusCodes
            (required to http://hl7.org/fhir/ValueSet/fm-status|4.0.1)

            A code specifying the state of the resource instance.

            Typecode
            Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. Coverage.type
            Definition

            The type of the Entitlement for example community services card (CSC) or high user health card (HUHC).

            ShortEntitlement type such as CSC or HUHC.
            Control0..1
            BindingThe codes SHALL be taken from CoverageType (1.1.0)
            (required to https://nzhts.digital.health.nz/fhir/ValueSet/coverage-type-code|1.1.0)
            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. Coverage.policyHolder
            Definition

            The party who 'owns' the insurance policy.

            ShortOwner of the policy
            Comments

            For example: may be an individual, corporation or the subscriber's employer.

            Control0..0
            TypeReference(Patient, RelatedPerson, Organization)
            Is Modifierfalse
            Summarytrue
            Requirements

            This provides employer information in the case of Worker's Compensation and other policies.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. Coverage.subscriber
            Definition

            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.

            ShortSubscriber to the policy
            Comments

            May be self or a parent in the case of dependants.

            Control0..0
            TypeReference(Patient, RelatedPerson)
            Is Modifierfalse
            Summarytrue
            Requirements

            This is the party who is entitled to the benfits under the policy.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. Coverage.subscriberId
            Definition

            The insurer assigned ID for the Subscriber.

            ShortID assigned to the subscriber
            Control0..0
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            The insurer requires this identifier on correspondance and claims (digital and otherwise).

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. Coverage.beneficiary
            Definition

            The NHI number of the person who benefits from the entitlement

            ShortThe Health service user's NHI.
            Control1..1
            TypeReference(NES Patient)
            Is Modifierfalse
            Summarytrue
            Requirements

            This is the party who receives treatment for which the costs are reimbursed under the coverage.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. Coverage.dependent
            Definition

            A unique identifier for a dependent under the coverage.

            ShortDependent number
            Comments

            Periodically the member number is constructed from the subscriberId and the dependant number.

            Control0..0
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. Coverage.relationship
            Definition

            An attribute used to identify if this entitlement is dependent on another CSC entitlement. Child for CSC-dep

            ShortUsed to identify a CSC dependent
            Comments

            Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from SubscriberRelationshipCodes
            (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship)

            The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Requirements

            To determine relationship between the patient and the subscriber to determine coordination of benefits.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. Coverage.period
            Definition

            Time period of the entitlement. Period Start = Entitlement start date. Period end = Entitlement expiry date (active entitlements) or Entitlement end date (ended entitlements).

            ShortEntitlement Start and Expiry or End date
            Control0..1
            TypePeriod
            Is Modifierfalse
            Summarytrue
            Requirements

            Some insurers require the submission of the coverage term.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. Coverage.payor
            Definition

            The HPI Org Id for the organisation approving a Patient Entitlement.

            ShortOrganisation approving the entitlement.
            Comments

            May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.

            Control1..*
            TypeReference(Organization, Patient, RelatedPerson)
            Is Modifierfalse
            Summarytrue
            Requirements

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

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. Coverage.class
            Definition

            A suite of underwriter specific classifiers.

            ShortAdditional coverage classifications
            Comments

            For example may be used to identify a class of coverage or employer group, Policy, Plan.

            Control0..0
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

            The codes provided on the health card which identify or confirm the specific policy for the insurer.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. Coverage.order
            Definition

            The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.

            ShortRelative order of the coverage
            Control0..0
            TypepositiveInt
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Used in managing the coordination of benefits.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Coverage.network
            Definition

            The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.

            ShortInsurer network
            Control0..0
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Used in referral for treatment and in claims processing.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. Coverage.costToBeneficiary
            Definition

            A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.

            ShortPatient payments for services/products
            Comments

            For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.

            Control0..0
            TypeBackboneElement
            Is Modifierfalse
            Summaryfalse
            Requirements

            Required by providers to manage financial transaction with the patient.

            Alternate NamesCoPay, Deductible, Exceptions
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            83. Coverage.subrogation
            Definition

            When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.

            ShortReimbursement to insurer
            Comments

            Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.

            Control0..0
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Requirements

            See definition for when to be used.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            85. Coverage.contract
            Definition

            The policy(s) which constitute this insurance coverage.

            ShortContract details
            Control0..0
            TypeReference(Contract)
            Is Modifierfalse
            Summaryfalse
            Requirements

            To reference the legally binding contract between the policy holder and the insurer.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))