Coverage

FHIR resource from the Financial Management module.

Definition

Coverage captures the high-level details found on an insurance card: the beneficiary (patient), the subscriber, the payor (insurer) and the policy identifier. It is referenced by the Claim and ExplanationOfBenefit resources to attach a service to a coverage.

Origin

Defined in the HL7 FHIR specification (R4/R5), Financial Management module, published by HL7 International.

Example in context

<Coverage><status value="active"/><beneficiary><reference value="Patient/123"/></beneficiary><payor><reference value="Organization/ins1"/></payor></Coverage>

Related terms

• FHIR ExplanationOfBenefit — benefit statement linked to the coverage.