description: The US Core Coverage Profile inherits from the FHIR [Coverage](https://hl7.org/fhir/R4/coverage.html) resource; refer to it for scope and usage definitions. This profile meets the requirements of the US Core Data for Interoperability (USCDI) *Health Insurance Information* Data Class. It sets minimum expectations for the Coverage resource to record, search, and fetch data related to an individual's insurance coverage for health care. It specifies which core elements, extensions,  vocabularies, and value sets **SHALL** be present in the resource and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.
package_name: hl7.fhir.us.core
derivation: constraint
name: USCoreCoverageProfile
type: Coverage
elements:
  beneficiary:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient']
    index: 6
  relationship:
    binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/subscriber-relationship'}
    mustSupport: true
    index: 7
  type:
    binding: {strength: extensible, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'}
    mustSupport: true
    index: 4
  payor:
    type: Reference
    mustSupport: true
    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']
    index: 9
  status: {mustSupport: true, index: 3}
  class:
    mustSupport: true
    index: 10
    slicing:
      rules: open
      ordered: false
      description: Slice based on value pattern
      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: 11
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: group, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 12
              value: {short: Group Number, mustSupport: true, index: 13}
              name: {short: Group Name, mustSupport: true, index: 14}
        plan:
          match:
            type:
              coding:
              - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: Plan
            mustSupport: true
            index: 15
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: plan, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 16
              value: {short: Plan Number, mustSupport: true, index: 17}
              name: {short: Plan Name, mustSupport: true, index: 18}
  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
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: MB, system: 'http://terminology.hl7.org/CodeSystem/v2-0203'}
                index: 2
            required: [type]
  period: {mustSupport: true, index: 8}
  subscriberId: {mustSupport: true, index: 5}
package_version: 8.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage
base: http://hl7.org/fhir/StructureDefinition/Coverage
version: 8.0.0-ballot
required: [relationship]