IL Core Implementation Guide
0.18.0 - draft
This page is part of the IL-Core IG (v0.18.0: draft-1 Draft) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Official URL: http://fhir.health.gov.il/StructureDefinition/il-core-coverage | Version: 0.18.0 | |||
Standards status: Draft | Maturity Level: 0 | Computable Name: ILCoreCoverage |
Israel Core proposed constraints and extensions on the Coverage Resource
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |
policyHolder | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy | |
subscriber | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy | |
beneficiary | 1..1 | Reference(ILCore Patient Profile) | Plan beneficiary | |
payor | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy | |
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |
type | ||||
coding | ||||
system | 1..1 | uri | Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class | |
code | 1..1 | code | Symbol in syntax defined by the system Required Pattern: plan | |
value | 1..1 | string | Value associated with the type | |
name | 0..1 | string | Human readable description of the type and value | |
Documentation for this format |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 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. |
policyHolder | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy |
beneficiary | Σ | 1..1 | Reference(ILCore Patient Profile) | Plan beneficiary |
payor | Σ | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy |
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |
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, eg. Group, Plan, Class, etc. |
value | Σ | 1..1 | string | Value associated with the type |
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |
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, eg. Group, Plan, Class, etc. |
value | Σ | 1..1 | string | Value associated with the type |
name | Σ | 0..1 | string | Human readable description of the type and value |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | |
Coverage.class:plan.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |||||
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: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
policyHolder | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | Σ | 1..1 | Reference(ILCore 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 | ||||
payor | Σ | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy | ||||
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |||||
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, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |||||
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, eg. Group, Plan, Class, etc. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: plan | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
value | Σ | 1..1 | string | 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. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
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 | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
Coverage.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Coverage.type | preferred | CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard | ||||
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.class:plan.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard |
This structure is derived from Coverage
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |
policyHolder | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy | |
subscriber | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy | |
beneficiary | 1..1 | Reference(ILCore Patient Profile) | Plan beneficiary | |
payor | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy | |
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |
type | ||||
coding | ||||
system | 1..1 | uri | Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class | |
code | 1..1 | code | Symbol in syntax defined by the system Required Pattern: plan | |
value | 1..1 | string | Value associated with the type | |
name | 0..1 | string | Human readable description of the type and value | |
Documentation for this format |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
modifierExtension | ?! | 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. |
policyHolder | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy |
subscriber | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy |
beneficiary | Σ | 1..1 | Reference(ILCore Patient Profile) | Plan beneficiary |
payor | Σ | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy |
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |
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, eg. Group, Plan, Class, etc. |
value | Σ | 1..1 | string | Value associated with the type |
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |
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, eg. Group, Plan, Class, etc. |
value | Σ | 1..1 | string | Value associated with the type |
name | Σ | 0..1 | string | Human readable description of the type and value |
Documentation for this format |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | |
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | |
Coverage.class:plan.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | ILCore Coverage Profile | |||||
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: CommonLanguages (preferred): A human language.
| |||||
text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
contained | 0..* | Resource | Contained, inline Resources | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | ||||
policyHolder | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | Σ | 1..1 | Reference(ILCore 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 | ||||
payor | Σ | 1..* | Reference(ILCore Patient Profile | ILCore RelatedPerson Profile | ILCore Organization Profile) | Issuer of the policy | ||||
Slices for class | 0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by pattern:type | |||||
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, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
class:plan | 0..1 | BackboneElement | Additional coverage classifications | |||||
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, eg. Group, Plan, Class, etc. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
system | Σ | 1..1 | uri | Identity of the terminology system Required Pattern: http://terminology.hl7.org/CodeSystem/coverage-class | ||||
version | Σ | 0..1 | string | Version of the system - if relevant | ||||
code | Σ | 1..1 | code | Symbol in syntax defined by the system Required Pattern: plan | ||||
display | Σ | 0..1 | string | Representation defined by the system | ||||
userSelected | Σ | 0..1 | boolean | If this coding was chosen directly by the user | ||||
text | Σ | 0..1 | string | Plain text representation of the concept | ||||
value | Σ | 1..1 | string | 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. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
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 | |||||
Documentation for this format |
Path | Conformance | ValueSet | URI | |||
Coverage.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languages from the FHIR Standard | ||||
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard | ||||
Coverage.type | preferred | CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard | ||||
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.class:plan.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard |
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron