Coverage

Trial Use 4 Financial

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

Endpoints

devhttps://api.sandbox.ovok.com/fhir/R5/Coverage

Interaction	Method	Path
Read	GET	/fhir/R5/Coverage/[id]
Vread	GET	/fhir/R5/Coverage/[id]/_history/[vid]
Update	PUT	/fhir/R5/Coverage/[id]
Patch	PATCH	/fhir/R5/Coverage/[id]
Delete	DELETE	/fhir/R5/Coverage/[id]
Create	POST	/fhir/R5/Coverage
Search	GET	/fhir/R5/Coverage?...
History	GET	/fhir/R5/Coverage/[id]/_history
Type-history	GET	/fhir/R5/Coverage/_history

Top-level elements

Element	Type(s)	Cardinality	Description
identifier	Identifier	0..*	Business identifier(s) for this coverage
status	code	1..1	active
kind	code	1..1	insurance
paymentBy	BackboneElement	0..*	Self-pay parties and responsibility
type	CodeableConcept	0..1	Coverage category such as medical or accident
policyHolder	Reference	0..1	Owner of the policy
subscriber	Reference	0..1	Subscriber to the policy
subscriberId	Identifier	0..*	ID assigned to the subscriber
beneficiary	Reference	1..1	Plan beneficiary
dependent	string	0..1	Dependent number
relationship	CodeableConcept	0..1	Beneficiary relationship to the subscriber
period	Period	0..1	Coverage start and end dates
insurer	Reference	0..1	Issuer of the policy
class	BackboneElement	0..*	Additional coverage classifications
order	positiveInt	0..1	Relative order of the coverage
network	string	0..1	Insurer network
costToBeneficiary	BackboneElement	0..*	Patient payments for services/products
subrogation	boolean	0..1	Reimbursement to insurer
contract	Reference	0..*	Contract details
insurancePlan	Reference	0..1	Insurance plan details

Resource-specific search parameters

Parameter	Type	Description
beneficiary	reference	Covered party
class-type	token	Coverage class (e.g. plan, group)
class-value	token	Value of the class (e.g. Plan number, group number)
dependent	string	Dependent number
identifier	token	Account number
insurer	reference	The identity of the insurer
patient	reference	The entity that caused the expenses
paymentby-party	reference	Parties who will pay for services
policy-holder	reference	Reference to the policyholder
status	token	The status of the Coverage
subscriber	reference	Reference to the subscriber
subscriberid	token	Identifier of the subscriber
type	token	E.g. patient, expense, depreciation

Reference

• Official FHIR R5 spec: Coverage
• Maturity: Trial Use 4 (FMM 4).