HL7 Czech Base and Core FHIR IG
0.3.0 - ci-build

HL7 Czech Base and Core FHIR IG - Downloaded Version 0.3.0 See the Directory of published versions

## Resource Profile: Coverage (CZ core)

Official URL: https://hl7.cz/fhir/core/StructureDefinition/cz-coverage | Version: 0.3.0
Standards status: Trial-use | Maturity Level: 2 | Computable Name: CZ_Coverage

Czech national profile for coverage resource.

### Definice profilu

Tento profil specifikuje zdroj Coverage (dále Úhrada) v rámci českého národního projektu interoperability. Úhrada je určena k uložení informací souvisejících úhradou za poskytování produktů a služeb zdravotní péče. Zdroj lze použít, kromě záznamu informací o zdravotním pojitění také v případě samoplátců, tedy v případech kdy jednotlivec nebo organizace jsou jiní než pojistitel a přebírají odpovědnost za platbu části či celých nákladů na zdravotní péči.

### Důležité atributy

Následuje popis důležitých prvků profilu a jejich použití.

Identifier (Identifikátor platby)

Bussiness identifikátor v rámci pojistného krytí, v případě platby pojišťovnou vyplňte číslo pojistné smlouvy.

Payor (Plátce)

Informace o plátci léčby. Může se jednat o pojišťovnu, pacienta, osobu blízkou pacientovi nebo jinou organizaci.

SubscriberID (Identifikátor předplatitele/pojištěnce)

Identifikátor předplatitele (pacienta nebo příbuzné osoby), v případě platby pojišťovnou vyplňte číslo pojištěnce.

CostToBeneficiary (Náklady plátce)

Informace o krytí dodatečných nákladů plátcem (tzv. Samoplátce).

### Definition of profile

This profile presents the requirements for the Coverage resource within the Czech national interoperability project. Coverage is intended to provide identifiers for information that would appear on an insured person's card, which can be used for partial or full reimbursement for the provision of healthcare products and services. At the same time, this resource can also be used to register "self-payers," where the individual or organization are different from the insurer and assumes responsibility for paying some or all of the health care costs.

### Important elements

The following is a description of the most important profile elements and how they are used.

Identifier

Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).

Payor

Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.

SubscriberID

Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).

CostToBeneficiary

Information about the extra costs that are paid for by the payor (also known as Samoplátce).

Usages:

- Examples for this Profile: Coverage/Coverage01

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Czech coverage
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code"
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
policyHolder | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary | Σ | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
payor | Σ | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 |  | 0..* | Coverage | Czech coverage
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
identifier |  | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
type |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Binding: Číselník typů úhrady (required)
policyHolder |  | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber |  | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId |  | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary |  | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
payor |  | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.type.coding | Base | required | Číselník typů úhrady | 📦0.2.0 | HL7 Czech Terminology Implementation Guide v0.2

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Czech coverage
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code"
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: Číselník typů úhrady (required)
text | Σ | 0..1 | string | Plain text representation of the concept
policyHolder | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary | Σ | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | Σ | 0..1 | Period | Coverage start and end dates
payor | Σ | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
class |  | 0..* | 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 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value | Σ | 1..1 | string | Value associated with the type
name | Σ | 0..1 | string | Human readable description of the type and value
order | Σ | 0..1 | positiveInt | Relative order of the coverage
network | Σ | 0..1 | string | Insurer network
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
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 | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
exception |  | 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 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period | Σ | 0..1 | Period | The effective period of the exception
subrogation |  | 0..1 | boolean | Reimbursement to insurer
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std.
Coverage.type.coding | Base | required | Číselník typů úhrady | 📦0.2.0 | HL7 Czech Terminology Implementation Guide v0.2
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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

Structures

This structure refers to these other structures:

- Patient (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-patient-core)
- Related Person (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-relatedPerson-core)
- Organization (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-organization-core)

Extensions

This structure refers to these extensions:

- https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Czech coverage
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code"
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
policyHolder | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary | Σ | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
payor | Σ | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 |  | 0..* | Coverage | Czech coverage
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
identifier |  | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
type |  |  |  |
coding |  | 0..* | Coding | Code defined by a terminology system Binding: Číselník typů úhrady (required)
policyHolder |  | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber |  | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId |  | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary |  | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
payor |  | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.type.coding | Base | required | Číselník typů úhrady | 📦0.2.0 | HL7 Czech Terminology Implementation Guide v0.2

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Czech coverage
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:kodNahrady |  | 0..1 | (Complex) | Refund indicator code (VZP) URL: https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code"
value[x] |  | 0..1 | CodeableConcept | Allowance code (VZP – Náhrada za zdravotní péči) Binding: NahradyZaZdravotniPeci (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | Business identifier of the coverage. In the event of payment by an insurance company, enter the insurance assignment number (also known as Číslo pojistné smlouvy).
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
coding | Σ | 0..* | Coding | Code defined by a terminology system Binding: Číselník typů úhrady (required)
text | Σ | 0..1 | string | Plain text representation of the concept
policyHolder | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core) | Organization (CZ core)) | Owner of the policy
subscriber | Σ | 0..1 | Reference(Patient (CZ core) | Related Person (CZ core)) | Subscriber to the policy
subscriberId | Σ | 0..1 | string | Identifier of the subscriber (patient or related person). In the event of payment by an insurance company, enter the insured person's number (also known as Číslo pojištěnce).
beneficiary | Σ | 1..1 | Reference(Patient (CZ core)) | Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | Σ | 0..1 | Period | Coverage start and end dates
payor | Σ | 1..* | Reference(Patient (CZ core) | Organization (CZ core) | Related Person (CZ core)) | Information about the payor of the treatment. This could be an insurance company, a patient, a related person of patient or an another organisation.
class |  | 0..* | 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 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value | Σ | 1..1 | string | Value associated with the type
name | Σ | 0..1 | string | Human readable description of the type and value
order | Σ | 0..1 | positiveInt | Relative order of the coverage
network | Σ | 0..1 | string | Insurer network
costToBeneficiary |  | 0..* | BackboneElement | Information about the extra costs that are paid for by the payor (also known as Samoplátce).
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 | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
exception |  | 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 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period | Σ | 0..1 | Period | The effective period of the exception
subrogation |  | 0..1 | boolean | Reimbursement to insurer
contract |  | 0..* | Reference(Contract) | Contract details
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Coverage.extension:kodNahrady.​value[x] | Base | required | NahradyZaZdravotniPeci | 📦0.3.0 | This IG
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | FHIR Std.
Coverage.type.coding | Base | required | Číselník typů úhrady | 📦0.2.0 | HL7 Czech Terminology Implementation Guide v0.2
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | FHIR Std.
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | FHIR Std.
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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

Structures

This structure refers to these other structures:

- Patient (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-patient-core)
- Related Person (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-relatedPerson-core)
- Organization (CZ core) (https://hl7.cz/fhir/core/StructureDefinition/cz-organization-core)

Extensions

This structure refers to these extensions:

- https://hl7.cz/fhir/core/StructureDefinition/cz-refund-indicator-code

Maturity: 2

Other representations of profile: CSV, Excel, Schematron