The Nphies Coverage resource is used to convey each of the patient's insurance policies by providing insurance identifying information such as: the insurer, the beneficiary (patient), the patient's member Id, the 'group' and/or 'policy' numbers, and the eployer and subscriber details if the insiance is provided via employment. One or more instances of this resource appears in almost all eCLaims exchanges messages.

For example, consider the sample insurance card and Coverage structure shown below:

The above example would be rendered as a coverage resource shown below in this Health Insurance Card Example.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	DP_Identifier_A	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder	Σ	1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	SΣ	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
subscriberId	SΣ	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
dependent	SΣ	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	DP_Period_3	Coverage start and end dates
payor	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
class		1..*	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value	Σ	1..1	string	Value associated with the type Max Length:30
name	SΣ	0..1	string	Human readable description of the type and value Max Length:100
network	SΣ	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	SΣ	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SΣC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	SΣ	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : 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()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
identifier		1..*	DP_Identifier_A	Business Identifier for the coverage
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
type		1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder		1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	S	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
subscriberId	S	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary		1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
dependent	S	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	S	0..1	DP_Period_3	Coverage start and end dates
payor		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
class		1..*	BackboneElement	Additional coverage classifications
type		1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value		1..1	string	Value associated with the type Max Length:30
name	S	0..1	string	Human readable description of the type and value Max Length:100
network	S	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
type	S	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary Slice: Unordered, Open by type:$this
value[x]:valueQuantity	S	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
type		1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	S	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	DP_Identifier_A	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder	Σ	1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	SΣ	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
subscriberId	SΣ	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
dependent	SΣ	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	DP_Period_3	Coverage start and end dates
payor	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
class		1..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value	Σ	1..1	string	Value associated with the type Max Length:30
name	SΣ	0..1	string	Human readable description of the type and value Max Length:100
order	Σ	0..1	positiveInt	Relative order of the coverage
network	SΣ	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	SΣ	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SΣC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	SΣ	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
Coverage.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.subscriber.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.beneficiary.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : 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()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	DP_Identifier_A	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder	Σ	1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	SΣ	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
subscriberId	SΣ	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
dependent	SΣ	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	DP_Period_3	Coverage start and end dates
payor	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource Max Length:200
class		1..*	BackboneElement	Additional coverage classifications
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value	Σ	1..1	string	Value associated with the type Max Length:30
name	SΣ	0..1	string	Human readable description of the type and value Max Length:100
network	SΣ	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	SΣ	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SΣC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	SΣ	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : 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()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
identifier		1..*	DP_Identifier_A	Business Identifier for the coverage
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
type		1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder		1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	S	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
subscriberId	S	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary		1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
dependent	S	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	S	0..1	DP_Period_3	Coverage start and end dates
payor		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
class		1..*	BackboneElement	Additional coverage classifications
type		1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value		1..1	string	Value associated with the type Max Length:30
name	S	0..1	string	Human readable description of the type and value Max Length:100
network	S	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
type	S	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]		1..1	SimpleQuantity, Money	The amount or percentage due from the beneficiary Slice: Unordered, Open by type:$this
value[x]:valueQuantity	S	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
type		1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	S	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage	C	0..*	Coverage	Insurance or medical plan or a payment agreement Constraints: BV-00150, BV-00340, BV-00729
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	1..*	DP_Identifier_A	Business Identifier for the coverage
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
type	Σ	1..1	DP_CodeableConcept	Coverage category such as medical or accident Binding: Coverage Type (required)
policyHolder	Σ	1..1	DP_Reference_1(Nphies Policy Holder Organization | Nphies Patient)	Owner of the policy
subscriber	SΣ	0..1	DP_Reference_1or2a(Nphies Patient)	Subscriber to the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
subscriberId	SΣ	0..1	string	ID assigned to the subscriber Max Length:50
beneficiary	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Plan beneficiary
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
dependent	SΣ	0..1	string	Dependent number Max Length:10
relationship		1..1	DP_CodeableConcept	Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (required)
period	SΣ	0..1	DP_Period_3	Coverage start and end dates
payor	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Issuer of the policy
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Organization Identifier (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
class		1..*	BackboneElement	Additional coverage classifications
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (required)
value	Σ	1..1	string	Value associated with the type Max Length:30
name	SΣ	0..1	string	Human readable description of the type and value Max Length:100
order	Σ	0..1	positiveInt	Relative order of the coverage
network	SΣ	0..1	string	Insurer network Max Length:30
costToBeneficiary	S	0..*	BackboneElement	Patient payments for services/products
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	0..1	DP_CodeableConcept	Cost category Binding: Coverage Copay Type (required)
Slices for value[x]	Σ	1..1		The amount or percentage due from the beneficiary Slice: Unordered, Closed by type:$this
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
value[x]:valueQuantity	SΣ	0..1	DP_SimpleQuantity_1	The amount or percentage due from the beneficiary
value[x]:valueMoney	SΣC	0..1	DP_Money_SAR	The amount or percentage due from the beneficiary Constraints: BV-00090
exception	S	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	DP_CodeableConcept	Exception category Binding: Coverage Financial Exception Codes (required)
period	SΣ	0..1	DP_Period_3	The effective period of the exception
subrogation	S	0..1	boolean	Reimbursement to insurer
contract		0..*	Reference(Contract)	Contract details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
Coverage.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
Coverage.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Coverage.status	required	Pattern Value: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard
Coverage.type	required	CoverageType(a valid code from Coverage Type) http://nphies.sa/terminology/ValueSet/coverage-type From this IG
Coverage.subscriber.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.subscriber.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.subscriber.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.beneficiary.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.beneficiary.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.beneficiary.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type From this IG
Coverage.relationship	required	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship From the FHIR Standard
Coverage.payor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Coverage.payor.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
Coverage.payor.identifier.type	required	OrganizationIdentifier http://nphies.sa/terminology/ValueSet/organization-identifier-type From this IG
Coverage.class.type	required	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard
Coverage.costToBeneficiary.type	required	CoverageCopayType(a valid code from Coverage Copay Type) http://nphies.sa/terminology/ValueSet/coverage-copay-type From this IG
Coverage.costToBeneficiary.exception.type	required	CoverageFinancialException(a valid code from Coverage Financial Exception) http://nphies.sa/terminology/ValueSet/coverage-financial-exception From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00090	error	Coverage.costToBeneficiary.value[x]:valueMoney	Coverage costToBeneficiary valueMoney currency is not SAR. : currency = 'SAR'
BV-00150	error	Coverage	The coverage identifier must not be empty. : identifier.exists()
BV-00340	error	Coverage	Coverage status is not using the specified value 'active'. : status.exists() implies status='active'
BV-00729	error	Coverage	One and only one coverage.class.type = 'plan' SHALL be provided per coverage resource. : class.type.coding.where(code='plan').count() < 2
dom-2	error	Coverage	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Coverage	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 : 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()
dom-4	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Coverage	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Coverage	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Coverage

Summary

Mandatory: 8 elements
Must-Support: 13 elements

Structures

This structure refers to these other structures:

• DP_canonical (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical)
• DP_Identifier_A (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Policy Holder Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization)
• Nphies Patient (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• DP_Period_3 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-3)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• DP_SimpleQuantity_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-SimpleQuantity-1)
• DP_Money_SAR (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Money-SAR)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.costToBeneficiary.value[x]