EnrollEligCOB
Class Coverage

"Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment." - HL7 FHIR, Coverage

Attributes
Contract contract contract

"The policy(s) which constitute this insurance coverage." - HL7 FHIR, Coverage.contract

CostToBeneficiary costToBeneficiary costToBeneficiary

"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." - HL7 FHIR, Coverage.costToBeneficiary

CoveredPatient coveredPatient coveredPatient

"The party who benefits from the insurance coverage, the patient when services are provided." - HL7 FHIR, Coverage.beneficiary

Dependent dependent dependent

"A unique identifier for a dependent under the coverage." - HL7 FHIR, Coverage.dependent

GroupCoverage groupCoverage groupCoverage

"A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan." - HL7 FHIR, Coverage.grouping

«II» Id identifier identifier

"A unique identifier assigned to this coverage. 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." - HL7 FHIR, Coverage.identifier

Boolean isSubrogated isSubrogated

"When subrogation=true, this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. Typically, automotive and worker's compensation policies would be flagged with subrogation=true to enable healthcare payors to collect against accident claims." - HL7 FHIR, Coverage.subrogation

«CS» Code kind kind

"The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization." - HL7 FHIR, Coverage.type

Integer order order

"The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care." - HL7 FHIR, Coverage.order

«IVL_TS» Period period period

"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." - HL7 FHIR, Coverage.period

PlanOrPolicy planOrPolicy planOrPolicy
«ANY» Any policyHolder policyHolder

"The party who owns the insurance policy. For example: may be an individual, corporation or the subscriber's employer." - HL7 FHIR, Coverage.policyHolder
Note that in FHIR, this property is a pointer to a Patient, a RelatedPerson, or an Organization. In FHIM, this is modeled as an Any to accomodate the different possible target types. In the FHIM, if the policyHolder is the Patient, that person can be reached through the coveredPatient association. If the policy holder is a RelatedPerson, that person could be reached through the Subscriber association. if the policyHolder is an Organization, that organization can be reached through the groupCoverage.planSponsor relationship. This property is included in the FHIM as a convenience so the navigation through these associations can be avoided.

String sequence sequence

"An optional counter for a particular instance of the identified coverage which increments upon each renewal. [Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their card.]" - HL7 FHIR, Coverage.sequence

«CS» Code status status

"The status of the resource instance." Possible values are: Active; Cancelled; Draft; Entered in Error. - HL7 FHIR, Coverage.status

Subscriber subscriber subscriber

"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." - HL7 FHIR, Coverage.subscriber


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NameCoverage
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::Coverage
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 contract
Public Contract contract

"The policy(s) which constitute this insurance coverage." - HL7 FHIR, Coverage.contract

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_contract
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namecontract
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::contract
Stereotype
Template Parameter
TypeContract
Upper1
Upper Value(1)
VisibilityPublic


 costToBeneficiary
Public CostToBeneficiary costToBeneficiary

"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." - HL7 FHIR, Coverage.costToBeneficiary

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_costToBeneficiary
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
NamecostToBeneficiary
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::costToBeneficiary
Stereotype
Template Parameter
TypeCostToBeneficiary
Upper*
Upper Value(*)
VisibilityPublic


 coveredPatient
Public CoveredPatient coveredPatient

"The party who benefits from the insurance coverage, the patient when services are provided." - HL7 FHIR, Coverage.beneficiary

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_coveredPatient
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamecoveredPatient
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::coveredPatient
Stereotype
Template Parameter
TypeCoveredPatient
Upper1
Upper Value(1)
VisibilityPublic


 dependent
Public Dependent dependent

"A unique identifier for a dependent under the coverage." - HL7 FHIR, Coverage.dependent

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_dependent
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Namedependent
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::dependent
Stereotype
Template Parameter
TypeDependent
Upper*
Upper Value(*)
VisibilityPublic


 groupCoverage
Public GroupCoverage groupCoverage

"A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan." - HL7 FHIR, Coverage.grouping

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_groupCoverage
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamegroupCoverage
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::groupCoverage
Stereotype
Template Parameter
TypeGroupCoverage
Upper1
Upper Value(1)
VisibilityPublic


 identifier
Public «II» Id identifier

"A unique identifier assigned to this coverage. 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." - HL7 FHIR, Coverage.identifier

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity*
Nameidentifier
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::identifier
Stereotype
Template Parameter
Type«II» Id
Upper*
Upper Value(*)
VisibilityPublic


 isSubrogated
Public Boolean isSubrogated

"When subrogation=true, this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs. Typically, automotive and worker's compensation policies would be flagged with subrogation=true to enable healthcare payors to collect against accident claims." - HL7 FHIR, Coverage.subrogation

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameisSubrogated
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::isSubrogated
Stereotype
Template Parameter
TypeBoolean
Upper1
Upper Value(1)
VisibilityPublic


 kind
Public «CS» Code kind

"The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization." - HL7 FHIR, Coverage.type

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Terminologies[
HL7_FHIR_R4 Coverage Type and Self-Pay Codes http://hl7.org/fhir/ValueSet/coverage-type
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namekind
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::kind
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 order
Public Integer order

"The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care." - HL7 FHIR, Coverage.order

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameorder
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::order
Stereotype
Template Parameter
TypeInteger
Upper1
Upper Value(1)
VisibilityPublic


 period
Public «IVL_TS» Period period

"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." - HL7 FHIR, Coverage.period

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Nameperiod
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::period
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 planOrPolicy
Public PlanOrPolicy planOrPolicy
Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_planOrPolicy
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NameplanOrPolicy
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::planOrPolicy
Stereotype
Template Parameter
TypePlanOrPolicy
Upper1
Upper Value(1)
VisibilityPublic


 policyHolder
Public «ANY» Any policyHolder

"The party who owns the insurance policy. For example: may be an individual, corporation or the subscriber's employer." - HL7 FHIR, Coverage.policyHolder
Note that in FHIR, this property is a pointer to a Patient, a RelatedPerson, or an Organization. In FHIM, this is modeled as an Any to accomodate the different possible target types. In the FHIM, if the policyHolder is the Patient, that person can be reached through the coveredPatient association. If the policy holder is a RelatedPerson, that person could be reached through the Subscriber association. if the policyHolder is an Organization, that organization can be reached through the groupCoverage.planSponsor relationship. This property is included in the FHIM as a convenience so the navigation through these associations can be avoided.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamepolicyHolder
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::policyHolder
Stereotype
Template Parameter
Type«ANY» Any
Upper1
Upper Value(1)
VisibilityPublic


 sequence
Public String sequence

"An optional counter for a particular instance of the identified coverage which increments upon each renewal. [Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their card.]" - HL7 FHIR, Coverage.sequence

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namesequence
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::sequence
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic


 status
Public «CS» Code status

"The status of the resource instance." Possible values are: Active; Cancelled; Draft; Entered in Error. - HL7 FHIR, Coverage.status

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassCoverage
Terminologies[
HL7_FHIR_R4 Financial Resource Status Codes http://hl7.org/fhir/ValueSet/fm-status
]
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namestatus
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::status
StereotypeValueSetConstraints
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 subscriber
Public Subscriber subscriber

"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." - HL7 FHIR, Coverage.subscriber

Constraints:
Properties:

AggregationNone
Alias
Associationcoverage_subscriber
Association End
ClassCoverage
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
Namesubscriber
Name Expression
NamespaceCoverage
Opposite
OwnerCoverage
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::Coverage::subscriber
Stereotype
Template Parameter
TypeSubscriber
Upper1
Upper Value(1)
VisibilityPublic