description: The US Core Coverage Profile is based upon the core FHIR Coverage Resource and implements the US Core Data for Interoperability (USCDI) v3 Health Insurance Information requirements. To promote interoperability and adoption through common implementation, this profile sets minimum expectations for the Coverage resource to record, search, and fetch the \"data related to an individual's insurance coverage for health care\". It identifies which core elements, extensions, vocabularies, and value sets **SHALL** be present in the resource and constrains the way the elements are used when using this profile. It provides the floor for standards development for specific use cases.
package_name: rs/hl7.fhir.us.core
derivation: constraint
name: USCoreCoverageProfile
type: Coverage
elements:
  beneficiary:
    type: Reference
    short: (USCDI) Plan beneficiary
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient']
    index: 6
  relationship:
    short: (USCDI) Beneficiary relationship to the subscriber
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/subscriber-relationship'}
    mustSupport: true
    index: 7
  type:
    short: (USCDI) Coverage category such as medical or accident
    binding: {strength: extensible, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'}
    mustSupport: true
    index: 4
  payor:
    short: (USCDI) Issuer of the policy
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson']
    type: Reference
    mustSupport: true
    index: 9
  status: {short: (USCDI) active | cancelled | draft | entered-in-error, mustSupport: true, index: 3}
  class:
    short: (USCDI) Additional coverage classifications
    mustSupport: true
    index: 10
    slicing:
      rules: open
      ordered: false
      description: Slice based on value pattern
      discriminator:
      - {path: type, type: pattern}
      min: null
      slices:
        group:
          match:
            type:
              coding:
              - {code: group, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: (USCDI) Group
            mustSupport: true
            index: 11
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: group, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                type: CodeableConcept
                index: 12
              value: {short: (USCDI) Group Number, mustSupport: true, index: 13}
              name: {short: (USCDI) Group Name, mustSupport: true, index: 14}
        plan:
          match:
            type:
              coding:
              - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: (USCDI) Plan
            mustSupport: true
            index: 15
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                type: CodeableConcept
                index: 16
              value: {short: (USCDI) Plan Number, mustSupport: true, index: 17}
              name: {short: (USCDI) Plan Name, mustSupport: true, index: 18}
  identifier:
    short: (USCDI) Member ID and other identifiers
    mustSupport: true
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: type, type: pattern}
      min: null
      slices:
        memberid:
          match:
            type:
              coding:
              - {code: MB, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
          schema:
            short: (USCDI) Member ID
            mustSupport: true
            index: 1
            elements:
              type:
                short: (USCDI) Member Number identifier type
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: MB, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
                type: CodeableConcept
                index: 2
            required: [type]
  period: {short: (USCDI) Coverage start and end dates, mustSupport: true, index: 8}
  subscriberId: {short: (USCDI) ID assigned to the subscriber, mustSupport: true, index: 5}
package_version: 6.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage
base: http://hl7.org/fhir/StructureDefinition/Coverage
version: 6.0.0
required: [relationship]