Moderne Patient:innenabrechnung und Datenkommunikation on FHIR (MOPED) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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Resource Profile: SVCCoverage

SVC Profil der Coverage Ressource für Versicherungen. Basierend auf dem Profil "ecardAnspruch": https://www.chipkarte.at/de/vdas-on-fhir/site/StructureDefinition-ecard-anspruch-profile.html

Usage:

• Use this Resource Profile: MOPED Aufnahme Bundle
• Refer to this Resource Profile: MOPEDClaim, MOPEDClaimResponse, MOPEDCoverageEligibilityRequest and MOPEDCoverageEligibilityResponse
• Examples for this Resource Profile: Coverage/Test1SVCCoverage and Coverage/Test2SVCCoverage

Formal Views of Profile Content

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

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

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage			Coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
type		0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
subscriber		0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
beneficiary		1..1	Reference(HL7® AT Core Patient Profile)	Plan beneficiary
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
type	Σ	0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
subscriber	Σ	0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
beneficiary	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Plan beneficiary
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	Value associated with the type
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
value	Σ	1..1	Identifier	Value associated with the type
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
value	Σ	1..1	Identifier	Value associated with the type
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 from the FHIR Standard
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Constraints

Id	Grade	Path(s)	Details	Requirements
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
paymentBy		0..*	BackboneElement	Self-pay parties and responsibility
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
party	Σ	1..1	Reference(Patient | RelatedPerson | Organization)	Parties performing self-payment
responsibility	Σ	0..1	string	Party's responsibility
type	Σ	0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
subscriberId	Σ	0..*	Identifier	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(HL7® AT Core Patient Profile)	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
insurer	Σ	0..1	Reference(Organization)	Issuer of the policy
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system
display	ΣC	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	Σ	1..1	Identifier	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system
display	ΣC	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	Σ	1..1	Identifier	Value associated with the type
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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example)
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example)
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example)
value[x]	Σ	0..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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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
insurancePlan		0..1	Reference(InsurancePlan)	Insurance plan details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 from the FHIR Standard
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Coverage.costToBeneficiary.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
Coverage.costToBeneficiary.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
Coverage.costToBeneficiary.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Must-Support: 2 elements

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
• http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.class

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage			Coverage
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
type		0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
subscriber		0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
beneficiary		1..1	Reference(HL7® AT Core Patient Profile)	Plan beneficiary
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
coding
system		0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
type	Σ	0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
subscriber	Σ	0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
beneficiary	Σ	1..1	Reference(HL7® AT Core Patient Profile)	Plan beneficiary
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	Value associated with the type
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
value	Σ	1..1	Identifier	Value associated with the type
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
value	Σ	1..1	Identifier	Value associated with the type
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 from the FHIR Standard
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html

Constraints

Id	Grade	Path(s)	Details	Requirements
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id	Σ	0..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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter Set
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
RezeptgebbefreitExtension		0..1	boolean	Rezeptgebührenbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
KostenanteilbefreitExtension		0..1	boolean	Kostenanteilbefreit laut Versicherungsanspruch URL: http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
paymentBy		0..*	BackboneElement	Self-pay parties and responsibility
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
party	Σ	1..1	Reference(Patient | RelatedPerson | Organization)	Parties performing self-payment
responsibility	Σ	0..1	string	Party's responsibility
type	Σ	0..1	CodeableConcept	Anspruchsart Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html (required)
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(HL7® AT Core Patient Profile)	Subscriber to the policy
subscriberId	Σ	0..*	Identifier	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(HL7® AT Core Patient Profile)	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
insurer	Σ	0..1	Reference(Organization)	Issuer of the policy
Slices for class		0..*	BackboneElement	Additional coverage classifications Slice: Unordered, Open by value:type.coding.code
class:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:Versichertenarten	S	0..1	BackboneElement	Versichertenarten
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html (required)
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenart-cs
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system
display	ΣC	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	Σ	1..1	Identifier	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
class:Versichertenkategorien	S	0..1	BackboneElement	Versichertenkategorien
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Type of class such as 'group' or 'plan' Binding: https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html (required)
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	0..1	code	Symbol in syntax defined by the system
display	ΣC	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	Σ	1..1	Identifier	Value associated with the type
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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example)
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example)
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example)
value[x]	Σ	0..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
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
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
insurancePlan		0..1	Reference(InsurancePlan)	Insurance plan details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 from the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 from the FHIR Standard
Coverage.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-anspruchsarten-vs.html
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.class:Versichertenarten.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenarten-vs.html
Coverage.class:Versichertenkategorien.type	required	https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html https://www.chipkarte.at/de/vdas-on-fhir/site/ValueSet-ecard-versichertenkategorien-vs.html
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
Coverage.costToBeneficiary.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network from the FHIR Standard
Coverage.costToBeneficiary.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit from the FHIR Standard
Coverage.costToBeneficiary.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Must-Support: 2 elements

Structures

This structure refers to these other structures:

• HL7® AT Core Patient Profile (http://hl7.at/fhir/HL7ATCoreProfiles/5.0.0/StructureDefinition/at-core-patient)

Extensions

This structure refers to these extensions:

• http://example.org/StructureDefinition/ecard-anspruch-rezeptgebbefreit
• http://example.org/StructureDefinition/ecard-anspruch-kostenanteilbefreit

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.class

Other representations of profile: CSV, Excel, Schematron