Coverage

This topic describes information for the Coverage resource.

To interact with the REST endpoints in the Coverage resource, see Coverage.

Overview

The Coverage resource provides high-level information about an insurance plan for a specific person or patient or an encounter. Identifying coverage information would appear on an insurance card and can be used to pay for health care services. The resource can also be used for self-pay where an individual takes responsibility for the cost of healthcare services, rather than a company or organization.

The following fields are returned if valued:

• Coverage id

• Status

• Type

• Subscriber of policy

• Subscriber id

• Beneficiary relationship to subscriber

• Plan beneficiary

• Dependent number

• Start/end time of the coverage

• Payor

• Class

  • Type

  • Value

  • Name

• Extensions including encounter (for more information, see the Extensions section of this topic)

Terminology Bindings

• Coverage.relationship

  Description: Indicates the beneficiary relationship to the subscriber.

  • Details: Subscriber Relationship

    System: http://terminology.hl7.org/CodeSystem/subscriber-relationship

  • Details: For more information, see Code Set 40 Person Relationships under the List of Code Sets section in Proprietary Codes and Systems.

    System: https://fhir.cerner.com/<EHR_source_id>/codeSet/40

Extensions

Table - Extensions

ID	Value[x} Type	Description
coverage-encounter	Reference	A reference to an encounter.