{
  "resourceType": "StructureDefinition",
  "id": "pr-insurance-coverage",
  "meta": {
    "source": "https://www.icanbwell.com/fhir_profile_definitions",
    "security": [
      {
        "system": "https://www.icanbwell.com/owner",
        "code": "bwell"
      },
      {
        "system": "https://www.icanbwell.com/access",
        "code": "bwell"
      }
    ]
  },
  "url": "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-insurance-coverage",
  "version": "1.1",
  "name": "InsuranceCoverage",
  "title": "Profile: Insurance Coverage",
  "status": "active",
  "experimental": false,
  "date": "2023-11-08T18:50:34.9562827+00:00",
  "publisher": "b.Well Connected Health",
  "description": "Insurance coverage for a beneficiary",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ],
      "text": "United States of America"
    }
  ],
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Coverage",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Coverage.id",
        "path": "Coverage.id",
        "min": 1
      },
      {
        "id": "Coverage.meta",
        "path": "Coverage.meta",
        "label": "meta",
        "min": 1,
        "type": [
          {
            "code": "Meta",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-meta"
            ]
          }
        ]
      },
      {
        "id": "Coverage.identifier",
        "path": "Coverage.identifier",
        "label": "identifier",
        "slicing": {
          "description": "slice by types",
          "rules": "open"
        },
        "short": "a value to identify the resource by",
        "type": [
          {
            "code": "Identifier",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-identifier"
            ]
          }
        ]
      },
      {
        "id": "Coverage.identifier.use",
        "path": "Coverage.identifier.use",
        "label": "identifier"
      },
      {
        "id": "Coverage.identifier:identifier-member-number",
        "path": "Coverage.identifier",
        "sliceName": "identifier-member-number",
        "label": "member-number",
        "code": [
          {
            "system": "https://www.icanbwell.com/product-feature-code"
          }
        ],
        "short": "insurance coverage's unique identifier for the individual",
        "requirements": "system = source URI",
        "patternIdentifier": {
          "id": "member-number",
          "type": {
            "coding": [
              {
                "id": "member-number-type",
                "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code": "MB"
              }
            ]
          }
        }
      },
      {
        "id": "Coverage.identifier:medicare-beneficiary-id",
        "path": "Coverage.identifier",
        "sliceName": "medicare-beneficiary-id",
        "label": "medicare-beneficiary-id",
        "short": "Medicare Beneficiary Identifier (US)",
        "patternIdentifier": {
          "id": "mbi",
          "type": {
            "coding": [
              {
                "id": "mbi-type",
                "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code": "MC"
              }
            ]
          },
          "system": "http://hl7.org/fhir/sid/us-mbi"
        }
      },
      {
        "id": "Coverage.status",
        "path": "Coverage.status",
        "short": "Indicates validity of the resource",
        "comment": "record should remain active, even after coverage termination",
        "mustSupport": true
      },
      {
        "id": "Coverage.type",
        "path": "Coverage.type",
        "short": "Type of coverage represented",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://www.hl7.org/fhir/us/bwell/bwell-vs-coverage-type"
        }
      },
      {
        "id": "Coverage.subscriber",
        "path": "Coverage.subscriber",
        "short": "Subscriber of the insurance plan policy",
        "comment": "this may be the same individual as the beneficiary",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Coverage.subscriberId",
        "path": "Coverage.subscriberId",
        "short": "The subscribing individual's unique member number",
        "mustSupport": true
      },
      {
        "id": "Coverage.beneficiary",
        "path": "Coverage.beneficiary",
        "short": "Beneficiary of the insurance plan coverage",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Coverage.dependent",
        "path": "Coverage.dependent",
        "short": "Sequence number for the dependent",
        "requirements": "Only needed if the individual is a dependent; If the individual is the subscriber, this should be omitted",
        "mustSupport": true
      },
      {
        "id": "Coverage.relationship",
        "path": "Coverage.relationship",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://www.hl7.org/fhir/us/bwell/bwell-vs-relationship"
        }
      },
      {
        "id": "Coverage.period",
        "path": "Coverage.period",
        "short": "Effective date range",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Coverage.payor",
        "path": "Coverage.payor",
        "short": "Paying entity",
        "comment": "Typically the Insurance Company",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-insurance-company",
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/pr-partner-organization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Coverage.class",
        "path": "Coverage.class",
        "slicing": {
          "description": "Slice by type",
          "rules": "open"
        },
        "definition": "The codes provided on the health card which identify or confirm the specific policy for the insurer.",
        "mustSupport": true
      },
      {
        "id": "Coverage.class.type",
        "path": "Coverage.class.type",
        "short": "Coded value to describe the class",
        "definition": "The policy classifications, eg. Group, Plan, Class, etc.",
        "type": [
          {
            "code": "CodeableConcept",
            "profile": [
              "https://fhir.icanbwell.com/4_0_0/StructureDefinition/de-codeable-concept"
            ]
          }
        ],
        "example": [
          {
            "label": "Group type",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                  "code": "group"
                }
              ]
            }
          }
        ],
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://www.hl7.org/fhir/us/bwell/bwell-vs-coverage-class-type"
        }
      },
      {
        "id": "Coverage.class.value",
        "path": "Coverage.class.value",
        "mustSupport": true
      },
      {
        "id": "Coverage.class.name",
        "path": "Coverage.class.name",
        "mustSupport": true
      },
      {
        "id": "Coverage.class:Group",
        "path": "Coverage.class",
        "sliceName": "Group",
        "short": "Insurance coverage group"
      },
      {
        "id": "Coverage.class:Group.id",
        "path": "Coverage.class.id",
        "min": 1
      },
      {
        "id": "Coverage.class:Group.type",
        "path": "Coverage.class.type",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code": "group"
            }
          ]
        }
      },
      {
        "id": "Coverage.class:Subgroup",
        "path": "Coverage.class",
        "sliceName": "Subgroup",
        "short": "Insurance coverage subgroup"
      },
      {
        "id": "Coverage.class:Subgroup.id",
        "path": "Coverage.class.id",
        "min": 1
      },
      {
        "id": "Coverage.class:Subgroup.type",
        "path": "Coverage.class.type",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code": "subgroup"
            }
          ]
        }
      }
    ]
  }
}