labcomplete AIS-Schnittstelle - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Resource Profile: Versicherung
| Official URL: https://fhir.labcomplete.at/ais/v1/StructureDefinition/ais-coverage | Version: 0.1.0 | |||
| Draft as of 2026-10-29 | Computable Name: AisCoverage | |||
Copyright/Legal: © 2026 medcom GmbH. Alle Rechte vorbehalten. |
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class mit type group trägt die Versichertenkategorie der e-card wie in ELGA MOPED; insurer ist die Kasse.
Usages:
- Use this Profil: request-create and request-updated
- Refer to this Profil: Anforderung aus dem AIS and Anforderung
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.
| Name | Flags | Card. | Type | Description & Constraints Filter:  |
|---|---|---|---|---|
  Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer |
  implicitRules |
0..1 | uri | A set of rules under which this content was created | |
| contained |
0..* | Resource | Contained, inline Resources | |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| status |
1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |
| kind |
1..1 | code | insurance | self-pay | other Binding: Kind (required) | |
 subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |
| beneficiary |
1..1 | Reference(Patient) | Plan beneficiary | |
 relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |
  Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
   class:All Slices |
Content/Rules for all slices | |||
  modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. | |
 value |
1..1 | Identifier | Value associated with the type | |
  class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. Required Pattern: | |
 value |
1..1 | Identifier | Value associated with the type | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |
 system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |
| Documentation for this format | ||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std. |
| Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.use | Base | required | IdentifierUse | 📍5.0.0 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
| 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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: |
|---|---|---|---|---|
| Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer |
| kind |
1..1 | code | insurance | self-pay | other | |
| subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |
| relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber | |
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |
| Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: | |
| value |
||||
| system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |
| Documentation for this format | ||||
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer | ||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
| |||||
| 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 | |||||
 extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
0..* | Identifier | Business identifier(s) for this coverage | |||||
| status |
1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |||||
| kind |
1..1 | code | insurance | self-pay | other Binding: Kind (required) | |||||
 paymentBy |
0..* | BackboneElement | Self-pay parties and responsibility | |||||
 id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| party |
1..1 | Reference(Patient | RelatedPerson | Organization) | Parties performing self-payment | |||||
| responsibility |
0..1 | string | Party's responsibility | |||||
| type |
0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | |||||
| policyHolder |
0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | |||||
| subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |||||
| subscriberId |
0..* | Identifier | ID assigned to the subscriber | |||||
| beneficiary |
1..1 | Reference(Patient) | Plan beneficiary | |||||
| dependent |
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 |
0..1 | Period | Coverage start and end dates | |||||
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |||||
| Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| class:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. | |||||
| value |
1..1 | Identifier | Value associated with the type | |||||
| name |
0..1 | string | Human readable description of the type and value | |||||
| class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. Required Pattern: | |||||
 value |
1..1 | Identifier | Value associated with the type | |||||
 id |
0..1 | id | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |||||
| type |
0..1 | CodeableConcept | Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||
| system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |||||
| value |
C | 0..1 | string | The value that is unique Beispiel General: 123456 | ||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
 name |
0..1 | string | Human readable description of the type and value | |||||
| order |
0..1 | positiveInt | Relative order of the coverage | |||||
| network |
0..1 | string | Insurer network | |||||
| costToBeneficiary |
0..* | BackboneElement | Patient payments for services/products | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |||||
| network |
0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example) | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example) | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example) | |||||
 value[x] |
0..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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
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 |
0..1 | Period | The effective period of the exception | |||||
| subrogation |
0..1 | boolean | Reimbursement to insurer | |||||
| contract |
0..* | Reference(Contract) | Contract details | |||||
| insurancePlan |
0..1 | Reference(InsurancePlan) | Insurance plan details | |||||
| Documentation for this format | ||||||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | required | All Languages | 📍5.0.0 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std. |
| Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍5.0.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.use | Base | required | IdentifierUse | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.type | Base | extensible | Identifier Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.network | Base | example | Network Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.unit | Base | example | Unit Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.term | Base | example | Benefit Term Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍5.0.0 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
| 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
|
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer |
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |
| contained |
0..* | Resource | Contained, inline Resources | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| status |
1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |
| kind |
1..1 | code | insurance | self-pay | other Binding: Kind (required) | |
| subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |
| beneficiary |
1..1 | Reference(Patient) | Plan beneficiary | |
| relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |
| Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| class:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. | |
| value |
1..1 | Identifier | Value associated with the type | |
| class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. Required Pattern: | |
| value |
1..1 | Identifier | Value associated with the type | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |
| system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |
| Documentation for this format | ||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std. |
| Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.use | Base | required | IdentifierUse | 📍5.0.0 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
| 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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: |
|---|---|---|---|---|
| Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer |
| kind |
1..1 | code | insurance | self-pay | other | |
| subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |
| relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber | |
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |
| Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |
| class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie |
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Required Pattern: | |
| value |
||||
| system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |
| Documentation for this format | ||||
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage |
C | 0..* | Coverage | Insurance or medical plan or a payment agreement Constraints: ais-coverage-insurer | ||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: AllLanguages (required): IETF language tag for a human language
| |||||
| 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 | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
0..* | Identifier | Business identifier(s) for this coverage | |||||
| status |
1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | |||||
| kind |
1..1 | code | insurance | self-pay | other Binding: Kind (required) | |||||
| paymentBy |
0..* | BackboneElement | Self-pay parties and responsibility | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| party |
1..1 | Reference(Patient | RelatedPerson | Organization) | Parties performing self-payment | |||||
| responsibility |
0..1 | string | Party's responsibility | |||||
| type |
0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelfPayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. | |||||
| policyHolder |
0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | |||||
| subscriber |
0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | |||||
| subscriberId |
0..* | Identifier | ID assigned to the subscriber | |||||
| beneficiary |
1..1 | Reference(Patient) | Plan beneficiary | |||||
| dependent |
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 |
0..1 | Period | Coverage start and end dates | |||||
| insurer |
0..1 | Reference(Kasse) | Issuer of the policy | |||||
| Slices for class |
0..* | BackboneElement | Additional coverage classifications Slice: Unordered, Open by value:type Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them | |||||
| class:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. | |||||
| value |
1..1 | Identifier | Value associated with the type | |||||
| name |
0..1 | string | Human readable description of the type and value | |||||
| class:versichertenkategorie |
C | 0..1 | BackboneElement | Additional coverage classifications Constraints: ais-versichertenkategorie | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, e.g. Group, Plan, Class, etc. Required Pattern: | |||||
| value |
1..1 | Identifier | Value associated with the type | |||||
| id |
0..1 | id | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | |||||
| type |
0..1 | CodeableConcept | Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. | |||||
| system |
0..1 | uri | The namespace for the identifier value Required Pattern: http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs (extensions allowed) | |||||
| value |
C | 0..1 | string | The value that is unique Beispiel General: 123456 | ||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| name |
0..1 | string | Human readable description of the type and value | |||||
| order |
0..1 | positiveInt | Relative order of the coverage | |||||
| network |
0..1 | string | Insurer network | |||||
| costToBeneficiary |
0..* | BackboneElement | Patient payments for services/products | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | |||||
| category |
0..1 | CodeableConcept | Benefit classification Binding: BenefitCategoryCodes (example) | |||||
| network |
0..1 | CodeableConcept | In or out of network Binding: NetworkTypeCodes (example) | |||||
| unit |
0..1 | CodeableConcept | Individual or family Binding: UnitTypeCodes (example) | |||||
| term |
0..1 | CodeableConcept | Annual or lifetime Binding: BenefitTermCodes (example) | |||||
| value[x] |
0..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 |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| type |
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 |
0..1 | Period | The effective period of the exception | |||||
| subrogation |
0..1 | boolean | Reimbursement to insurer | |||||
| contract |
0..* | Reference(Contract) | Contract details | |||||
| insurancePlan |
0..1 | Reference(InsurancePlan) | Insurance plan details | |||||
| Documentation for this format | ||||||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | required | All Languages | 📍5.0.0 | FHIR Std. |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍5.0.0 | FHIR Std. |
| Coverage.kind | Base | required | Kind | 📍5.0.0 | FHIR Std. |
| Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍5.0.0 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.type | Base | extensible | Coverage Class Codes | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.use | Base | required | IdentifierUse | 📍5.0.0 | FHIR Std. |
| Coverage.class:versichertenkategorie.value.type | Base | extensible | Identifier Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.category | Base | example | Benefit Category Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.network | Base | example | Network Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.unit | Base | example | Unit Type Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.term | Base | example | Benefit Term Codes | 📍5.0.0 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📍5.0.0 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Beschreibung | Expression |
| ais-coverage-insurer | error | Coverage | Eine Versicherung (kind insurance) nennt die Kasse, eine Privatverrechnung (self-pay) keine. |
(kind = 'insurance' implies insurer.exists()) and (kind = 'self-pay' implies insurer.empty())
|
| ais-versichertenkategorie | error | Coverage.class:versichertenkategorie | Die Versichertenkategorie ist ein zweistelliger Code aus http://svc.co.at/CodeSystem/ecard-versichertenkategorie-cs |
value.value.matches('^[0-9]{2}$')
|
| 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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()
|
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