<status value="active" /> <experimental value="false" /> <description value="The set of coverage elements returned for individual private or bpcs coverage when returning a 'summary'" /> <fhirVersion value="5.0.0" /> <mapping> <identity value="BPCS" /> <name value="Internal BPCS API" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Coverage" /> <baseDefinition value="https://bpcs.exchange/fhir/StructureDefinition/profile-Coverage-individual-public-create" /> <derivation value="constraint" /> <differential> <element id="Coverage.id"> <path value="Coverage.id" /> <short value="Unique identifier assigned to the coverage" /> <comment value="This id is used when querying history" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.plan '.' program '.' odbNum '.' effDate" /> </mapping> </element> <element id="Coverage.meta"> <path value="Coverage.meta" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.meta.versionId"> <path value="Coverage.meta.versionId" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.recUpdateCustomTimestamp (concatenate time and nanos)" /> </mapping> </element> <element id="Coverage.meta.lastUpdated"> <path value="Coverage.meta.lastUpdated" /> <min value="1" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.recUpdateCustomTimestamp (convert to valid FHIR format timestamp)" /> </mapping> </element> <element id="Coverage.contained"> <path value="Coverage.contained" /> <slicing> <discriminator> <type value="profile" /> <path value="$this" /> </discriminator> <rules value="open" /> </slicing> <min value="1" /> </element> <element id="Coverage.contained:provenance"> <path value="Coverage.contained" /> <sliceName value="provenance" /> <short value="Creation/Update/etc. Metadata" /> <definition value="Nested Provenance information referring to this resource that describes the creation, and sometimes the most recent update and/or inactivation of the record, specifically who was responsible and when it occurred" /> <min value="1" /> <type> <code value="Provenance" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Provenance" /> </type> <mustSupport value="true" /> </element> <element id="Coverage.extension:goodFaith"> <path value="Coverage.extension" /> <sliceName value="goodFaith" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-GoodFaith" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.goodFaith (boolean, or true if date), RecipientPlanDTO.faithConfirmed (date)" /> </mapping> </element> <element id="Coverage.class"> <path value="Coverage.class" /> <slicing> <rules value="open" /> </slicing> </element> <element id="Coverage.class:program"> <path value="Coverage.class" /> <sliceName value="program" /> </element> <element id="Coverage.class:program.name"> <path value="Coverage.class.name" /> <comment value="This will be omitted for private plans" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.planDescription" /> </mapping> </element> <element id="Coverage.class:plan"> <path value="Coverage.class" /> <sliceName value="plan" /> </element> <element id="Coverage.class:plan.name"> <path value="Coverage.class.name" /> <comment value="This will be omitted for private plans" /> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientPlanDTO.planDescription" /> </mapping> </element> <element id="Coverage.costToBeneficiary"> <path value="Coverage.costToBeneficiary" /> <slicing> <discriminator> <type value="value" /> <path value="type" /> </discriminator> <discriminator> <type value="value" /> <path value="unit" /> </discriminator> <discriminator> <type value="value" /> <path value="term" /> </discriminator> <rules value="open" /> </slicing> </element> <element id="Coverage.costToBeneficiary:deductible"> <path value="Coverage.costToBeneficiary" /> <sliceName value="deductible" /> <comment value="Deductible information will only be available for BPCS-managed coverages" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.costToBeneficiary:deductible.extension:deductibleCalculation"> <path value="Coverage.costToBeneficiary.extension" /> <sliceName value="deductibleCalculation" /> <type> <code value="Extension" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/ext-Coverage-DeductibleCalculation" /> </type> <mustSupport value="true" /> </element> <element id="Coverage.costToBeneficiary:deductible.type"> <path value="Coverage.costToBeneficiary.type" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-copay-type" /> <code value="deductible" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:deductible.unit"> <path value="Coverage.costToBeneficiary.unit" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-unit" /> <code value="individual" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:deductible.term"> <path value="Coverage.costToBeneficiary.term" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-term" /> <code value="annual" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:deductible.value[x]"> <path value="Coverage.costToBeneficiary.value[x]" /> <comment value="This SHALL equal the base + adjustment amounts in the deductibleCalculation extension" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientDeductibleDTO.netDeductibleAmount" /> </mapping> </element> <element id="Coverage.costToBeneficiary:copay"> <path value="Coverage.costToBeneficiary" /> <sliceName value="copay" /> <comment value="Copay information will only be available for BPCS-managed coverages" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Coverage.costToBeneficiary:copay.type"> <path value="Coverage.costToBeneficiary.type" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/coverage-copay-type" /> <code value="copay" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:copay.unit"> <path value="Coverage.costToBeneficiary.unit" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-unit" /> <code value="individual" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:copay.term"> <path value="Coverage.costToBeneficiary.term" /> <min value="1" /> <patternCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/benefit-term" /> <code value="annual" /> </coding> </patternCodeableConcept> </element> <element id="Coverage.costToBeneficiary:copay.value[x]"> <path value="Coverage.costToBeneficiary.value[x]" /> <min value="1" /> <type> <code value="Money" /> <profile value="https://bpcs.exchange/fhir/StructureDefinition/profile-Money-CAD" /> </type> <mustSupport value="true" /> <mapping> <identity value="BPCS" /> <map value="RecipientDeductibleDTO.copayCeilingAmount" /> </mapping> </element> </differential> </StructureDefinition>