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13.1 JSON Schema for Coverage

Financial Management Work GroupMaturity Level: N/ABallot Status: Informative Compartments: Patient, RelatedPerson

This is a representation of the json schema for Coverage, which is just a part of the full JSON Schema.

{
  "$schema": "http://json-schema.org/draft-06/schema#",
  "id": "http://hl7.org/fhir/json-schema/Coverage",
  "$ref": "#/definitions/Coverage",
  "description": "see http://hl7.org/fhir/json.html#schema for information about the FHIR Json Schemas",
  "definitions": {
    "Coverage": {
      "description": "Финансовый инструмент, который может быть использован для оплаты или компенсации за продукты и услуги в области здравоохранения. Includes both insurance and self-payment.",
      "properties": {
        "resourceType": {
          "description": "This is a Coverage resource",
          "const": "Coverage"
        },
        "id": {
          "description": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
          "$ref": "id.schema.json#/definitions/id"
        },
        "meta": {
          "description": "Метаданные ресурса. Это такая информация, которая поддерживается инфраструктурой. Изменения этой информации не всегда можно ассоциировать с версионными изменениями ресурса.",
          "$ref": "Meta.schema.json#/definitions/Meta"
        },
        "implicitRules": {
          "description": "Ссылка на свод правил, которым следовали при создании этого ресурса и которые необходимо понимать при обработке этого содержимого. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
          "$ref": "#/definitions/uri"
        },
        "_implicitRules": {
          "description": "Extensions for implicitRules",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "language": {
          "description": "Основной язык, на котором написан ресурс.",
          "$ref": "#/definitions/code"
        },
        "_language": {
          "description": "Extensions for language",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "text": {
          "description": "Человекочитаемая описательная часть, содержащая краткое изложение ресурса, которая может использоваться для представления содержимого ресурса человеку. От описательной части не требуется кодировать все структурированные данные, но она должна содержать достаточно сведений, чтобы простое её прочтение человеком было \"клинически безопасным\". Определения ресурсов могут описывать, какое содержимое должно быть представлено в описательной части для обеспечения клинической безопасной.",
          "$ref": "Narrative.schema.json#/definitions/Narrative"
        },
        "contained": {
          "description": "Эти ресурсы не обладают независимым существованием вне ресурса, который их содержит - их нельзя идентифицировать независимо, и они не могут иметь своей собственной независимой транзакционной области действия.",
          "items": {
            "$ref": "ResourceList.schema.json#/definitions/ResourceList"
          },
          "type": "array"
        },
        "extension": {
          "description": "Может использоваться для представления дополнительной информации, не являющейся частью базового определения ресурса. Чтобы сделать использование расширений надежным и управляемым, существует строгий набор управления применительно к определению и использованию расширений. Хотя каждому реализатору разрешается определять расширения, имеется набор требований, которые должны выполняться в рамках определения расширения.",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "modifierExtension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "identifier": {
          "description": "A unique identifier assigned to this coverage.",
          "items": {
            "$ref": "Identifier.schema.json#/definitions/Identifier"
          },
          "type": "array"
        },
        "status": {
          "description": "The status of the resource instance.",
          "$ref": "#/definitions/code"
        },
        "_status": {
          "description": "Extensions for status",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "type": {
          "description": "The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.",
          "$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
        },
        "policyHolder": {
          "description": "The party who \u0027owns\u0027 the insurance policy.",
          "$ref": "Reference.schema.json#/definitions/Reference"
        },
        "subscriber": {
          "description": "The party who has signed-up for or \u0027owns\u0027 the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.",
          "$ref": "Reference.schema.json#/definitions/Reference"
        },
        "subscriberId": {
          "description": "The insurer assigned ID for the Subscriber.",
          "$ref": "#/definitions/string"
        },
        "_subscriberId": {
          "description": "Extensions for subscriberId",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "beneficiary": {
          "description": "The party who benefits from the insurance coverage; the patient when products and/or services are provided.",
          "$ref": "Reference.schema.json#/definitions/Reference"
        },
        "dependent": {
          "description": "Уникальный идентификатор материально зависимого лица страхового покрытия.",
          "$ref": "#/definitions/string"
        },
        "_dependent": {
          "description": "Extensions for dependent",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "relationship": {
          "description": "The relationship of beneficiary (patient) to the subscriber.",
          "$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
        },
        "period": {
          "description": "Период действия страхового покрытия. Отсутствие даты начала означает, что дата начала действия не известна, отсутствие даты окончания значит, что страховое покрытие продолжает оставаться в силе.",
          "$ref": "Period.schema.json#/definitions/Period"
        },
        "payor": {
          "description": "The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.",
          "items": {
            "$ref": "Reference.schema.json#/definitions/Reference"
          },
          "type": "array"
        },
        "class": {
          "description": "A suite of underwriter specific classifiers.",
          "items": {
            "$ref": "#/definitions/Coverage_Class"
          },
          "type": "array"
        },
        "order": {
          "description": "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.",
          "$ref": "#/definitions/positiveInt"
        },
        "_order": {
          "description": "Extensions for order",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "network": {
          "description": "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the \u0027in-network\u0027 rate, otherwise \u0027out of network\u0027 terms and conditions apply.",
          "$ref": "#/definitions/string"
        },
        "_network": {
          "description": "Extensions for network",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "costToBeneficiary": {
          "description": "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been  included on the health card.",
          "items": {
            "$ref": "#/definitions/Coverage_CostToBeneficiary"
          },
          "type": "array"
        },
        "subrogation": {
          "description": "When \u0027subrogation\u003dtrue\u0027 this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.",
          "$ref": "#/definitions/boolean"
        },
        "_subrogation": {
          "description": "Extensions for subrogation",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "contract": {
          "description": "Страховой полис(-ы), который подтверждает это страховое покрытие.",
          "items": {
            "$ref": "Reference.schema.json#/definitions/Reference"
          },
          "type": "array"
        }
      },
      "additionalProperties": false,
      "required": [
        "payor",
        "beneficiary",
        "resourceType"
      ]
    },
    "Coverage_Class": {
      "description": "Финансовый инструмент, который может быть использован для оплаты или компенсации за продукты и услуги в области здравоохранения. Includes both insurance and self-payment.",
      "properties": {
        "id": {
          "description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
          "$ref": "string.schema.json#/definitions/string"
        },
        "extension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "modifierExtension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "type": {
          "description": "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.",
          "$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
        },
        "value": {
          "description": "The alphanumeric string value associated with the insurer issued label.",
          "$ref": "#/definitions/string"
        },
        "_value": {
          "description": "Extensions for value",
          "$ref": "Element.schema.json#/definitions/Element"
        },
        "name": {
          "description": "A short description for the class.",
          "$ref": "#/definitions/string"
        },
        "_name": {
          "description": "Extensions for name",
          "$ref": "Element.schema.json#/definitions/Element"
        }
      },
      "additionalProperties": false,
      "required": [
        "type"
      ]
    },
    "Coverage_CostToBeneficiary": {
      "description": "Финансовый инструмент, который может быть использован для оплаты или компенсации за продукты и услуги в области здравоохранения. Includes both insurance and self-payment.",
      "properties": {
        "id": {
          "description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
          "$ref": "string.schema.json#/definitions/string"
        },
        "extension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "modifierExtension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "type": {
          "description": "The category of patient centric costs associated with treatment.",
          "$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
        },
        "valueQuantity": {
          "description": "The amount due from the patient for the cost category.",
          "$ref": "Quantity.schema.json#/definitions/Quantity"
        },
        "valueMoney": {
          "description": "The amount due from the patient for the cost category.",
          "$ref": "Money.schema.json#/definitions/Money"
        },
        "exception": {
          "description": "A suite of codes indicating exceptions or reductions to patient costs and their effective periods.",
          "items": {
            "$ref": "#/definitions/Coverage_Exception"
          },
          "type": "array"
        }
      },
      "additionalProperties": false
    },
    "Coverage_Exception": {
      "description": "Финансовый инструмент, который может быть использован для оплаты или компенсации за продукты и услуги в области здравоохранения. Includes both insurance and self-payment.",
      "properties": {
        "id": {
          "description": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
          "$ref": "string.schema.json#/definitions/string"
        },
        "extension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "modifierExtension": {
          "description": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
          "items": {
            "$ref": "Extension.schema.json#/definitions/Extension"
          },
          "type": "array"
        },
        "type": {
          "description": "The code for the specific exception.",
          "$ref": "CodeableConcept.schema.json#/definitions/CodeableConcept"
        },
        "period": {
          "description": "The timeframe during when the exception is in force.",
          "$ref": "Period.schema.json#/definitions/Period"
        }
      },
      "additionalProperties": false,
      "required": [
        "type"
      ]
    }
  }
}