xib-Coverage
type: StructureDefinition
node role: treeRoot
id:
  v: xib-Coverage
text:
  status:
    v: extensions
  div:
    v: Gegenereerde narrative: StructureDefinition xib-Coverage Naam Markeringen Kard. Type Omschrijving & constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Coverage 0..* Coverage Insurance or medical plan or a payment agreement #xD; identifier S 0..* Identifier Business Identifier for the coverage #xD; status S 1..1 code active | cancelled | draft | entered-in-error #xD; type S 0..1 CodeableConcept Coverage category such as medical or accident #xD; beneficiary S 1..1 Reference(Patient) Plan beneficiary #xD; payor S 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentatie voor dit formaat
url:
  v: https://fhir.cumuluz.org/xib/StructureDefinition/xib-Coverage
  l: xib-Coverage
version:
  v: 0.1.0
name:
  v: XibCoverage
title:
  v: XIB Coverage
status:
  v: draft
date:
  v: 2026-07-11T10:05:40+02:00
publisher:
  v: Cumuluz
description:
  v: Generic XIB coverage target for nl-core Coverage profiles.
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: workflow
  uri:
    v: http://hl7.org/fhir/workflow
    l: workflow
  name:
    v: Workflow Pattern
mapping:
  identity:
    v: rim
  uri:
    v: http://hl7.org/v3
    l: v3
  name:
    v: RIM Mapping
mapping:
  identity:
    v: w5
  uri:
    v: http://hl7.org/fhir/fivews
    l: fivews
  name:
    v: FiveWs Pattern Mapping
mapping:
  identity:
    v: cdanetv4
  uri:
    v: http://www.cda-adc.ca/en/services/cdanet/
    l: cdanet
  name:
    v: Canadian Dental Association eclaims standard
mapping:
  identity:
    v: v2
  uri:
    v: http://hl7.org/v2
    l: v2
  name:
    v: HL7 v2 Mapping
mapping:
  identity:
    v: cpha3pharm
  uri:
    v: http://www.pharmacists.ca/
    l: www.pharmacists.ca
  name:
    v: Canadian Pharmacy Associaiton eclaims standard
kind:
  v: resource
abstract:
  v: false
type:
  v: Coverage
  l: Coverage
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Coverage
  l: Coverage
derivation:
  v: constraint
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 4.0.1
  element:
    id:
      v: Coverage
    path:
      v: Coverage
    short:
      v: Insurance or medical plan or a payment agreement
    definition:
      v: Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
    comment:
      v: The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: Coverage
      min:
        v: 0
      max:
        v: *
    constraint:
      key:
        v: dom-2
      severity:
        v: error
      human:
        v: If the resource is contained in another resource, it SHALL NOT contain nested Resources
      expression:
        v: contained.contained.empty()
      xpath:
        v: not(parent::f:contained and f:contained)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-3
      severity:
        v: error
      human:
        v: 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
      expression:
        v: 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()
      xpath:
        v: not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-4
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
      expression:
        v: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      key:
        v: dom-5
      severity:
        v: error
      human:
        v: If a resource is contained in another resource, it SHALL NOT have a security label
      expression:
        v: contained.meta.security.empty()
      xpath:
        v: not(exists(f:contained/*/f:meta/f:security))
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    constraint:
      extension:
        value: Boolean
      extension:
        value: Markdown
      key:
        v: dom-6
      severity:
        v: warning
      human:
        v: A resource should have narrative for robust management
      expression:
        v: text.`div`.exists()
      xpath:
        v: exists(f:text/h:div)
      source:
        v: http://hl7.org/fhir/StructureDefinition/DomainResource
        l: DomainResource
    is modifier:
      v: false
    is summary:
      v: false
    mapping:
      identity:
        v: rim
      map:
        v: Entity. Role, or Act
    mapping:
      identity:
        v: workflow

Boolean
v: true

Markdown
v: When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.

v: Event

identity:
  v: rim
map:
  v: Coverage

id:
  v: Coverage.id
path:
  v: Coverage.id
short:
  v: Logical id of this artifact
definition:
  v: The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
comment:
  v: The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: id
      l: id
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: true

id:
  v: Coverage.meta
path:
  v: Coverage.meta
short:
  v: Metadata about the resource
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.meta
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Meta
    l: Meta
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Coverage.implicitRules
path:
  v: Coverage.implicitRules
short:
  v: A set of rules under which this content was created
definition:
  v: 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.
comment:
  v: 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.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.implicitRules
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: uri
    l: uri
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: true
is modifier reason:
  v: 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
is summary:
  v: true

id:
  v: Coverage.language
path:
  v: Coverage.language
short:
  v: Language of the resource content
definition:
  v: The base language in which the resource is written.
comment:
  v: 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).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Resource.language
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet
      l: elementdefinition-maxValueSet
    value: Canonical
      v: http://hl7.org/fhir/ValueSet/all-languages
      l: all-languages
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Language
  strength:
    v: preferred
  description:
    v: A human language.
  value set:
    v: http://hl7.org/fhir/ValueSet/languages|4.0.1
    l: http://hl7.org/fhir/ValueSet/languages

id:
  v: Coverage.text
path:
  v: Coverage.text
short:
  v: Text summary of the resource, for human interpretation
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: narrative
alias:
  v: html
alias:
  v: xhtml
alias:
  v: display
min:
  v: 0
max:
  v: 1
base:
  path:
    v: DomainResource.text
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Narrative
    l: Narrative
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: Act.text?

id:
  v: Coverage.contained
path:
  v: Coverage.contained
short:
  v: Contained, inline Resources
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: inline resources
alias:
  v: anonymous resources
alias:
  v: contained resources
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.contained
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Resource
    l: Resource
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.extension
path:
  v: Coverage.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.modifierExtension
path:
  v: Coverage.modifierExtension
short:
  v: Extensions that cannot be ignored
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: DomainResource.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.identifier
path:
  v: Coverage.identifier
short:
  v: Business Identifier for the coverage
definition:
  v: A unique identifier assigned to this coverage.
comment:
  v: 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.
requirements:
  v: Allows coverages to be distinguished and referenced.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Coverage.identifier
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Identifier
    l: Identifier
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.identifier
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.identifier
mapping:
  identity:
    v: cdanetv4
  map:
    v: C02
mapping:
  identity:
    v: v2
  map:
    v: IN1-2
mapping:
  identity:
    v: rim
  map:
    v: .id
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.32, C.33, C.39

id:
  v: Coverage.status
path:
  v: Coverage.status
short:
  v: active | cancelled | draft | entered-in-error
definition:
  v: The status of the resource instance.
comment:
  v: This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
requirements:
  v: 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'.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.status
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: code
    l: code
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: true
is modifier reason:
  v: 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
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CoverageStatus
  strength:
    v: required
  description:
    v: A code specifying the state of the resource instance.
  value set:
    v: http://hl7.org/fhir/ValueSet/fm-status|4.0.1
    l: http://hl7.org/fhir/ValueSet/fm-status
mapping:
  identity:
    v: workflow
  map:
    v: Event.status
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.status
mapping:
  identity:
    v: rim
  map:
    v: Act.status

id:
  v: Coverage.type
path:
  v: Coverage.type
short:
  v: Coverage category such as medical or accident
definition:
  v: The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
requirements:
  v: The order of application of coverages is dependent on the types of coverage.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CoverageType
  strength:
    v: preferred
  description:
    v: The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverage-type|4.0.1
    l: http://hl7.org/fhir/ValueSet/coverage-type
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.class
mapping:
  identity:
    v: v2
  map:
    v: IN1-15

id:
  v: Coverage.policyHolder
path:
  v: Coverage.policyHolder
short:
  v: Owner of the policy
definition:
  v: The party who 'owns' the insurance policy.
comment:
  v: For example: may be an individual, corporation or the subscriber's employer.
requirements:
  v: This provides employer information in the case of Worker's Compensation and other policies.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.policyHolder
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/RelatedPerson
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: D01 through D09
mapping:
  identity:
    v: v2
  map:
    v: IN1-16, 18, 19-name of insured, address, date of birth
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.35
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: Coverage.subscriber
path:
  v: Coverage.subscriber
short:
  v: Subscriber to the policy
definition:
  v: 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.
comment:
  v: May be self or a parent in the case of dependants.
requirements:
  v: This is the party who is entitled to the benfits under the policy.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.subscriber
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/RelatedPerson
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: D01 through D09
mapping:
  identity:
    v: v2
  map:
    v: IN1-16, 18, 19-name of insured, address, date of birth
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.35
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: Coverage.subscriberId
path:
  v: Coverage.subscriberId
short:
  v: ID assigned to the subscriber
definition:
  v: The insurer assigned ID for the Subscriber.
requirements:
  v: The insurer requires this identifier on correspondance and claims (digital and otherwise).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.subscriberId
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: D01 through D09
mapping:
  identity:
    v: v2
  map:
    v: IN1-16, 18, 19-name of insured, address, date of birth
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.35
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: Coverage.beneficiary
path:
  v: Coverage.beneficiary
short:
  v: Plan beneficiary
definition:
  v: The party who benefits from the insurance coverage; the patient when products and/or services are provided.
requirements:
  v: This is the party who receives treatment for which the costs are reimbursed under the coverage.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.beneficiary
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.subject
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject[x]
mapping:
  identity:
    v: cdanetv4
  map:
    v: D01 through D09
mapping:
  identity:
    v: v2
  map:
    v: IN1-16, 18, 19-name of insured, address, date of birth
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.35
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.subject

id:
  v: Coverage.dependent
path:
  v: Coverage.dependent
short:
  v: Dependent number
definition:
  v: A unique identifier for a dependent under the coverage.
comment:
  v: Periodically the member number is constructed from the subscriberId and the dependant number.
requirements:
  v: For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.dependent
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: cdanetv4
  map:
    v: C17
mapping:
  identity:
    v: v2
  map:
    v: - No exact HL7 v2 equivalent concept seems to exist;

id:
  v: Coverage.relationship
path:
  v: Coverage.relationship
short:
  v: Beneficiary relationship to the subscriber
definition:
  v: The relationship of beneficiary (patient) to the subscriber.
comment:
  v: Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
requirements:
  v: To determine relationship between the patient and the subscriber to determine coordination of benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.relationship
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: Relationship
  strength:
    v: extensible
  description:
    v: The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
  value set:
    v: http://hl7.org/fhir/ValueSet/subscriber-relationship|4.0.1
    l: http://hl7.org/fhir/ValueSet/subscriber-relationship
mapping:
  identity:
    v: cdanetv4
  map:
    v: C03

id:
  v: Coverage.period
path:
  v: Coverage.period
short:
  v: Coverage start and end dates
definition:
  v: 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.
requirements:
  v: Some insurers require the submission of the coverage term.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.period
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: workflow
  map:
    v: Event.occurrence[x]
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.done[x]
mapping:
  identity:
    v: v2
  map:
    v: IN1-12 / IN1-13
mapping:
  identity:
    v: rim
  map:
    v: Act.effectiveTime

id:
  v: Coverage.payor
path:
  v: Coverage.payor
short:
  v: Issuer of the policy
definition:
  v: The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
comment:
  v: 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.
requirements:
  v: Need to identify the issuer to target for claim processing and for coordination of benefit processing.
min:
  v: 1
max:
  v: *
base:
  path:
    v: Coverage.payor
  min:
    v: 1
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Organization|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Organization
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Patient|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Patient
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/RelatedPerson
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
must support:
  v: true
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: w5
  map:
    v: FiveWs.author
mapping:
  identity:
    v: cdanetv4
  map:
    v: A05
mapping:
  identity:
    v: v2
  map:
    v: IN1-3
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.30

id:
  v: Coverage.class
path:
  v: Coverage.class
short:
  v: Additional coverage classifications
definition:
  v: A suite of underwriter specific classifiers.
comment:
  v: For example may be used to identify a class of coverage or employer group, Policy, Plan.
requirements:
  v: The codes provided on the health card which identify or confirm the specific policy for the insurer.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Coverage.class
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Coverage.class.id
path:
  v: Coverage.class.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.class.extension
path:
  v: Coverage.class.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.class.modifierExtension
path:
  v: Coverage.class.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.class.type
path:
  v: Coverage.class.type
short:
  v: Type of class such as 'group' or 'plan'
definition:
  v: The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
requirements:
  v: The insurer issued label for a specific health card value.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.class.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CoverageClass
  strength:
    v: extensible
  description:
    v: The policy classifications, eg. Group, Plan, Class, etc.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverage-class|4.0.1
    l: http://hl7.org/fhir/ValueSet/coverage-class

id:
  v: Coverage.class.value
path:
  v: Coverage.class.value
short:
  v: Value associated with the type
definition:
  v: The alphanumeric string value associated with the insurer issued label.
comment:
  v: For example, the Group or Plan number.
requirements:
  v: The insurer issued label and value are necessary to identify the specific policy.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.class.value
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: cdanetv4
  map:
    v: C11 (Division,Section)
mapping:
  identity:
    v: v2
  map:
    v: IN1-8
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.31

id:
  v: Coverage.class.name
path:
  v: Coverage.class.name
short:
  v: Human readable description of the type and value
definition:
  v: A short description for the class.
requirements:
  v: Used to provide a meaningful description in correspondence to the patient.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.class.name
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: cdanetv4
  map:
    v: C11 (Division,Section)
mapping:
  identity:
    v: v2
  map:
    v: IN1-8
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.31

id:
  v: Coverage.order
path:
  v: Coverage.order
short:
  v: Relative order of the coverage
definition:
  v: 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.
requirements:
  v: Used in managing the coordination of benefits.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.order
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: positiveInt
    l: positiveInt
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: v2
  map:
    v: - No exact HL7 v2 equivalent concept seems to exist;

id:
  v: Coverage.network
path:
  v: Coverage.network
short:
  v: Insurer network
definition:
  v: 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.
requirements:
  v: Used in referral for treatment and in claims processing.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.network
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: string
    l: string
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: cdanetv4
  map:
    v: D10

id:
  v: Coverage.costToBeneficiary
path:
  v: Coverage.costToBeneficiary
short:
  v: Patient payments for services/products
definition:
  v: 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.
comment:
  v: For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
requirements:
  v: Required by providers to manage financial transaction with the patient.
alias:
  v: CoPay
alias:
  v: Deductible
alias:
  v: Exceptions
min:
  v: 0
max:
  v: *
base:
  path:
    v: Coverage.costToBeneficiary
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Coverage.costToBeneficiary.id
path:
  v: Coverage.costToBeneficiary.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.costToBeneficiary.extension
path:
  v: Coverage.costToBeneficiary.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.costToBeneficiary.modifierExtension
path:
  v: Coverage.costToBeneficiary.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.costToBeneficiary.type
path:
  v: Coverage.costToBeneficiary.type
short:
  v: Cost category
definition:
  v: The category of patient centric costs associated with treatment.
comment:
  v: For example visit, specialist visits, emergency, inpatient care, etc.
requirements:
  v: Needed to identify the category associated with the amount for the patient.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.costToBeneficiary.type
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CopayTypes
  strength:
    v: extensible
  description:
    v: The types of services to which patient copayments are specified.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverage-copay-type|4.0.1
    l: http://hl7.org/fhir/ValueSet/coverage-copay-type

id:
  v: Coverage.costToBeneficiary.value[x]
path:
  v: Coverage.costToBeneficiary.value[x]
short:
  v: The amount or percentage due from the beneficiary
definition:
  v: The amount due from the patient for the cost category.
comment:
  v: Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
requirements:
  v: Needed to identify the amount for the patient associated with the category.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.costToBeneficiary.value[x]
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: Quantity
    l: Quantity
  profile:
    v: http://hl7.org/fhir/StructureDefinition/SimpleQuantity|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/SimpleQuantity
type:
  code:
    v: Money
    l: Money
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
mapping:
  identity:
    v: cdanetv4
  map:
    v: C11 (Division,Section)
mapping:
  identity:
    v: v2
  map:
    v: IN1-8
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.31

id:
  v: Coverage.costToBeneficiary.exception
path:
  v: Coverage.costToBeneficiary.exception
short:
  v: Exceptions for patient payments
definition:
  v: A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
requirements:
  v: Required by providers to manage financial transaction with the patient.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Coverage.costToBeneficiary.exception
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Coverage.costToBeneficiary.exception.id
path:
  v: Coverage.costToBeneficiary.exception.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Element.id
  min:
    v: 0
  max:
    v: 1
type:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.costToBeneficiary.exception.extension
path:
  v: Coverage.costToBeneficiary.exception.extension
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
min:
  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: Coverage.costToBeneficiary.exception.modifierExtension
path:
  v: Coverage.costToBeneficiary.exception.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained 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 can 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    l: Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: Coverage.costToBeneficiary.exception.type
path:
  v: Coverage.costToBeneficiary.exception.type
short:
  v: Exception category
definition:
  v: The code for the specific exception.
requirements:
  v: Needed to identify the exception associated with the amount for the patient.
min:
  v: 1
max:
  v: 1
base:
  path:
    v: Coverage.costToBeneficiary.exception.type
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true
binding:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName
      l: elementdefinition-bindingName
    value: String
      v: CoverageFinancialException
  strength:
    v: example
  description:
    v: The types of exceptions from the part or full value of financial obligations such as copays.
  value set:
    v: http://hl7.org/fhir/ValueSet/coverage-financial-exception|4.0.1
    l: http://hl7.org/fhir/ValueSet/coverage-financial-exception

id:
  v: Coverage.costToBeneficiary.exception.period
path:
  v: Coverage.costToBeneficiary.exception.period
short:
  v: The effective period of the exception
definition:
  v: The timeframe during when the exception is in force.
requirements:
  v: Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.costToBeneficiary.exception.period
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: Period
    l: Period
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: true

id:
  v: Coverage.subrogation
path:
  v: Coverage.subrogation
short:
  v: Reimbursement to insurer
definition:
  v: When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
comment:
  v: Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
requirements:
  v: See definition for when to be used.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: Coverage.subrogation
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: boolean
    l: boolean
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false

id:
  v: Coverage.contract
path:
  v: Coverage.contract
short:
  v: Contract details
definition:
  v: The policy(s) which constitute this insurance coverage.
requirements:
  v: To reference the legally binding contract between the policy holder and the insurer.
min:
  v: 0
max:
  v: *
base:
  path:
    v: Coverage.contract
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Reference
    l: Reference
  target profile:
    v: http://hl7.org/fhir/StructureDefinition/Contract|4.0.1
    l: http://hl7.org/fhir/StructureDefinition/Contract
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: cdanetv4
  map:
    v: D01 through D09
mapping:
  identity:
    v: v2
  map:
    v: IN1-16, 18, 19
mapping:
  identity:
    v: rim
  map:
    v: n/a
mapping:
  identity:
    v: cpha3pharm
  map:
    v: C.35

element:
  id:
    v: Coverage
  path:
    v: Coverage
element:
  id:
    v: Coverage.identifier
  path:
    v: Coverage.identifier
  must support:
    v: true
element:
  id:
    v: Coverage.status
  path:
    v: Coverage.status
  must support:
    v: true
element:
  id:
    v: Coverage.type
  path:
    v: Coverage.type
  must support:
    v: true
element:
  id:
    v: Coverage.beneficiary
  path:
    v: Coverage.beneficiary
  must support:
    v: true
element:
  id:
    v: Coverage.payor
  path:
    v: Coverage.payor
  must support:
    v: true