description: The HRex Coverage Profile defines the constraints for representing a member's healthcare insurance information to the Payer for member match purposes. Coverage instances complying with this profile, sometimes together with the Patient which this profile references via `beneficiary`, allows a payer to identify a member in their system.  It aligns with the equivalent US Core profile, but diverges in that it does not require Patient.identifier for the beneficiary.
package_name: hl7.fhir.us.davinci
derivation: constraint
name: HRexCoverage
type: Coverage
elements:
  policyHolder:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson|7.0.0', 'http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-organization']
    index: 6
  beneficiary:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics']
    index: 8
  relationship:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-hrex/ValueSet/hrex-coverage-relationship'}
    mustSupport: true
    index: 10
  type:
    binding: {strength: extensible, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'}
    mustSupport: true
    index: 5
  payor:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-organization']
    index: 12
  status: {mustSupport: true, index: 4}
  class:
    index: 13
    slicing:
      rules: open
      discriminator:
      - {path: type, type: value}
      min: null
      slices:
        group:
          match:
            type:
              coding:
              - {code: group, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: Group
            mustSupport: true
            index: 14
            elements:
              type:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: group, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 15
              value: {short: Group Number, mustSupport: true, index: 16}
        plan:
          match:
            type:
              coding:
              - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: Plan
            mustSupport: true
            index: 17
            elements:
              type:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 18
              value: {short: Plan Number, mustSupport: true, index: 19}
              name: {short: Plan Name, mustSupport: true, index: 20}
  identifier:
    short: Member ID and other identifiers
    mustSupport: true
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: type, type: value}
      min: null
      slices:
        memberid:
          match:
            type:
              coding:
              - {code: MB, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
          schema:
            short: Member ID
            mustSupport: true
            index: 1
            elements:
              type:
                short: Member Number identifier type
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: MB, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
                index: 2
              value: {mustSupport: true, index: 3}
            required: [value, type]
  period: {mustSupport: true, index: 11}
  dependent: {mustSupport: true, index: 9}
  subscriberId: {short: Subscriber ID, mustSupport: true, index: 7}
package_version: hrex-1.1.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
base: http://hl7.org/fhir/StructureDefinition/Coverage
version: 1.1.0
required: [relationship]