fhir/plugins/org.eclipse.mdht.fhir.xsd/model/schemas/coverage.xsd

<?xml version="1.0" encoding="UTF-8"?>
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  Generated on Thu, Dec 27, 2018 22:37+1100 for FHIR v4.0.0 

  Note: the schemas &amp; schematrons do not contain all of the rules about what makes resources
  valid. Implementers will still need to be familiar with the content of the specification and with
  any profiles that apply to the resources in order to make a conformant implementation.

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<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" targetNamespace="http://hl7.org/fhir" elementFormDefault="qualified" version="1.0">
  <xs:include schemaLocation="fhir-base.xsd"/>
  <xs:element name="Coverage" type="Coverage">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="Coverage">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="DomainResource">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">A unique identifier assigned to this coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="status" minOccurs="1" maxOccurs="1" type="FinancialResourceStatusCodes">
            <xs:annotation>
              <xs:documentation xml:lang="en">The status of the resource instance.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="policyHolder" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who 'owns' the insurance policy.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subscriber" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subscriberId" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">The insurer assigned ID for the Subscriber.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="beneficiary" minOccurs="1" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The party who benefits from the insurance coverage; the patient when products and/or services are provided.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="dependent" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A unique identifier for a dependent under the coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="relationship" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The relationship of beneficiary (patient) to the subscriber.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="period" minOccurs="0" maxOccurs="1" type="Period">
            <xs:annotation>
              <xs:documentation xml:lang="en">Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="payor" minOccurs="1" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="class" type="Coverage.Class" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of underwriter specific classifiers.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="order" minOccurs="0" maxOccurs="1" type="positiveInt">
            <xs:annotation>
              <xs:documentation xml:lang="en">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.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">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.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="costToBeneficiary" type="Coverage.CostToBeneficiary" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">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.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subrogation" minOccurs="0" maxOccurs="1" type="boolean">
            <xs:annotation>
              <xs:documentation xml:lang="en">When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="contract" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The policy(s) which constitute this insurance coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.Class">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">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.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="value" minOccurs="1" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">The alphanumeric string value associated with the insurer issued label.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="name" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A short description for the class.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.CostToBeneficiary">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The category of patient centric costs associated with treatment.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:choice minOccurs="1" maxOccurs="1" >
            <xs:annotation>
              <xs:documentation xml:lang="en">The amount due from the patient for the cost category.</xs:documentation>
            </xs:annotation>
            <xs:element name="valueQuantity" type="Quantity"/>
            <xs:element name="valueMoney" type="Money"/>
          </xs:choice>
          <xs:element name="exception" type="Coverage.Exception" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">A suite of codes indicating exceptions or reductions to patient costs and their effective periods.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="Coverage.Exception">
    <xs:annotation>
      <xs:documentation xml:lang="en">Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The code for the specific exception.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="period" minOccurs="0" maxOccurs="1" type="Period">
            <xs:annotation>
              <xs:documentation xml:lang="en">The timeframe during when the exception is in force.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
</xs:schema>