### ----------------------------------------------------
### -- FHIR
### -- Licenses: Artistic-2.0
### -- Authors: Hugh Simpson
### -- File: t/resources/structureDefinition/Coverage.json
### ----------------------------------------------------
### -- Chunk 8 of 8
 a class of coverage or employer group, Policy, Plan.",
      "requirements" : "The codes provided on the health card which identify or confirm the specific policy for the insurer.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "Coverage.class.type",
      "path" : "Coverage.class.type",
      "short" : "Type of class such as 'group' or 'plan'",
      "definition" : "The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.",
      "requirements" : "The insurer issued label for a specific health card value.",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isSummary" : true,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "CoverageClass"
        }],
        "strength" : "extensible",
        "description" : "The policy classifications, eg. Group, Plan, Class, etc.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/coverage-class"
      }
    },
    {
      "id" : "Coverage.class.value",
      "path" : "Coverage.class.value",
      "short" : "Value associated with the type",
      "definition" : "The alphanumeric string value associated with the insurer issued label.",
      "comment" : "For example, the Group or Plan number.",
      "requirements" : "The insurer issued label and value are necessary to identify the specific policy.",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "cdanetv4",
        "map" : "C11 (Division,Section)"
      },
      {
        "identity" : "v2",
        "map" : "IN1-8"
      },
      {
        "identity" : "cpha3pharm",
        "map" : "C.31"
      }]
    },
    {
      "id" : "Coverage.class.name",
      "path" : "Coverage.class.name",
      "short" : "Human readable description of the type and value",
      "definition" : "A short description for the class.",
      "requirements" : "Used to provide a meaningful description in correspondence to the patient.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "cdanetv4",
        "map" : "C11 (Division,Section)"
      },
      {
        "identity" : "v2",
        "map" : "IN1-8"
      },
      {
        "identity" : "cpha3pharm",
        "map" : "C.31"
      }]
    },
    {
      "id" : "Coverage.order",
      "path" : "Coverage.order",
      "short" : "Relative order of the coverage",
      "definition" : "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.",
      "requirements" : "Used in managing the coordination of benefits.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "positiveInt"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "v2",
        "map" : "- No exact HL7 v2 equivalent concept seems to exist;"
      }]
    },
    {
      "id" : "Coverage.network",
      "path" : "Coverage.network",
      "short" : "Insurer network",
      "definition" : "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.",
      "requirements" : "Used in referral for treatment and in claims processing.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "string"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "cdanetv4",
        "map" : "D10"
      }]
    },
    {
      "id" : "Coverage.costToBeneficiary",
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString" : "CostToBeneficiary"
      }],
      "path" : "Coverage.costToBeneficiary",
      "short" : "Patient payments for services/products",
      "definition" : "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.",
      "comment" : "For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.",
      "requirements" : "Required by providers to manage financial transaction with the patient.",
      "alias" : ["CoPay",
      "Deductible",
      "Exceptions"],
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "Coverage.costToBeneficiary.type",
      "path" : "Coverage.costToBeneficiary.type",
      "short" : "Cost category",
      "definition" : "The category of patient centric costs associated with treatment.",
      "comment" : "For example visit, specialist visits, emergency, inpatient care, etc.",
      "requirements" : "Needed to identify the category associated with the amount for the patient.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isSummary" : true,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "CopayTypes"
        }],
        "strength" : "extensible",
        "description" : "The types of services to which patient copayments are specified.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/coverage-copay-type"
      }
    },
    {
      "id" : "Coverage.costToBeneficiary.value[x]",
      "path" : "Coverage.costToBeneficiary.value[x]",
      "short" : "The amount or percentage due from the beneficiary",
      "definition" : "The amount due from the patient for the cost category.",
      "comment" : "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.",
      "requirements" : "Needed to identify the amount for the patient associated with the category.",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Quantity",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/SimpleQuantity"]
      },
      {
        "code" : "Money"
      }],
      "isSummary" : true,
      "mapping" : [{
        "identity" : "cdanetv4",
        "map" : "C11 (Division,Section)"
      },
      {
        "identity" : "v2",
        "map" : "IN1-8"
      },
      {
        "identity" : "cpha3pharm",
        "map" : "C.31"
      }]
    },
    {
      "id" : "Coverage.costToBeneficiary.exception",
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
        "valueString" : "Exemption"
      }],
      "path" : "Coverage.costToBeneficiary.exception",
      "short" : "Exceptions for patient payments",
      "definition" : "A suite of codes indicating exceptions or reductions to patient costs and their effective periods.",
      "requirements" : "Required by providers to manage financial transaction with the patient.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "BackboneElement"
      }]
    },
    {
      "id" : "Coverage.costToBeneficiary.exception.type",
      "path" : "Coverage.costToBeneficiary.exception.type",
      "short" : "Exception category",
      "definition" : "The code for the specific exception.",
      "requirements" : "Needed to identify the exception associated with the amount for the patient.",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "isSummary" : true,
      "binding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString" : "CoverageFinancialException"
        }],
        "strength" : "example",
        "description" : "The types of exceptions from the part or full value of financial obligations such as copays.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/coverage-financial-exception"
      }
    },
    {
      "id" : "Coverage.costToBeneficiary.exception.period",
      "path" : "Coverage.costToBeneficiary.exception.period",
      "short" : "The effective period of the exception",
      "definition" : "The timeframe during when the exception is in force.",
      "requirements" : "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Period"
      }],
      "isSummary" : true
    },
    {
      "id" : "Coverage.subrogation",
      "path" : "Coverage.subrogation",
      "short" : "Reimbursement to insurer",
      "definition" : "When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.",
      "comment" : "Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.",
      "requirements" : "See definition for when to be used.",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "boolean"
      }]
    },
    {
      "id" : "Coverage.contract",
      "path" : "Coverage.contract",
      "short" : "Contract details",
      "definition" : "The policy(s) which constitute this insurance coverage.",
      "requirements" : "To reference the legally binding contract between the policy holder and the insurer.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/StructureDefinition/Contract"]
      }],
      "mapping" : [{
        "identity" : "cdanetv4",
        "map" : "D01 through D09"
      },
      {
        "identity" : "v2",
        "map" : "IN1-16, 18,  19"
      },
      {
        "identity" : "rim",
        "map" : "n/a"
      },
      {
        "identity" : "cpha3pharm",
        "map" : "C.35"
      }]
    }]
  }
}


