<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="KBV-PR-FOR-Coverage" />
  <url value="https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage" />
  <version value="1.3.1" />
  <name value="KBV_PR_FOR_Coverage" />
  <status value="active" />
  <date value="2026-01-09" />
  <publisher value="Kassenärztliche Bundesvereinigung (KBV)" />
  <fhirVersion value="4.0.1" />
  <kind value="resource" />
  <abstract value="false" />
  <type value="Coverage" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Coverage" />
  <derivation value="constraint" />
  <differential>
    <element id="Coverage">
      <path value="Coverage" />
      <definition value="Das Versicherungsverhältnis, welches genutzt werden kann, die Behandlungskosten zu tragen." />
      <constraint>
        <key value="-for-angabeIKzustaendigeKrankenkasseEGKPflicht" />
        <severity value="error" />
        <human value="Das IK der zustaendigen Krankenkasse ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement." />
        <expression value="(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies payor.identifier.exists()" />
      </constraint>
      <constraint>
        <key value="-for-angabeVersichertenartPflicht" />
        <severity value="error" />
        <human value="Die Versichertenart ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement." />
        <expression value="(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/versichertenart').exists()" />
      </constraint>
      <constraint>
        <key value="-for-angabeBesonderePersonengruppePflicht" />
        <severity value="error" />
        <human value="Die Besondere Personengruppe ist nicht vorhanden, sie ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement." />
        <expression value="(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/besondere-personengruppe').exists()" />
      </constraint>
      <constraint>
        <key value="-for-angabeIKKostentraegerVerbot" />
        <severity value="error" />
        <human value="Nur wenn der Kostentraeger vom Typ BG oder UK ist, dann kann das IK des Kostentraegers uebertragen werden" />
        <expression value="(type.coding.code='GKV' or type.coding.code='SKT' or type.coding.code='SEL' or type.coding.code='PKV') implies payor.identifier.extension('https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK').exists().not()" />
      </constraint>
      <constraint>
        <key value="-for-angabeDMPPflicht" />
        <severity value="error" />
        <human value="Das DMP-Kennzeichen ist nicht vorhanden, dieses ist aber bei den Kostentraegern vom Typ 'GKV', 'BG', 'SKT', 'PKV' oder 'UK' ein Pflichtelement." />
        <expression value="(type.coding.code='GKV' or type.coding.code='BG' or type.coding.code='SKT' or type.coding.code='UK' or type.coding.code='PKV') implies extension('http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen').exists()" />
      </constraint>
    </element>
    <element id="Coverage.id">
      <path value="Coverage.id" />
      <min value="1" />
      <mustSupport value="true" />
    </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" />
      <max value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.meta.lastUpdated">
      <path value="Coverage.meta.lastUpdated" />
      <max value="0" />
    </element>
    <element id="Coverage.meta.source">
      <path value="Coverage.meta.source" />
      <max value="0" />
    </element>
    <element id="Coverage.meta.profile">
      <path value="Coverage.meta.profile" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="$this" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.meta.profile:forProfile">
      <path value="Coverage.meta.profile" />
      <sliceName value="forProfile" />
      <min value="1" />
      <max value="1" />
      <fixedCanonical value="https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Coverage|1.3" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.meta.security">
      <path value="Coverage.meta.security" />
      <max value="0" />
    </element>
    <element id="Coverage.meta.tag">
      <path value="Coverage.meta.tag" />
      <max value="0" />
    </element>
    <element id="Coverage.implicitRules">
      <path value="Coverage.implicitRules" />
      <max value="0" />
    </element>
    <element id="Coverage.language">
      <path value="Coverage.language" />
      <max value="0" />
    </element>
    <element id="Coverage.text">
      <path value="Coverage.text" />
      <max value="0" />
    </element>
    <element id="Coverage.contained">
      <path value="Coverage.contained" />
      <max value="0" />
    </element>
    <element id="Coverage.extension">
      <path value="Coverage.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="closed" />
      </slicing>
      <max value="4" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe">
      <path value="Coverage.extension" />
      <sliceName value="BesonderePersonengruppe" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://fhir.de/StructureDefinition/gkv/besondere-personengruppe" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x]">
      <path value="Coverage.extension.value[x]" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x].system">
      <path value="Coverage.extension.value[x].system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x].version">
      <path value="Coverage.extension.value[x].version" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x].code">
      <path value="Coverage.extension.value[x].code" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x].display">
      <path value="Coverage.extension.value[x].display" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:BesonderePersonengruppe.value[x].userSelected">
      <path value="Coverage.extension.value[x].userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen">
      <path value="Coverage.extension" />
      <sliceName value="DMPKennzeichen" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x]">
      <path value="Coverage.extension.value[x]" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x].system">
      <path value="Coverage.extension.value[x].system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x].version">
      <path value="Coverage.extension.value[x].version" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x].code">
      <path value="Coverage.extension.value[x].code" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x].display">
      <path value="Coverage.extension.value[x].display" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:DMPKennzeichen.value[x].userSelected">
      <path value="Coverage.extension.value[x].userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:Versichertenart">
      <path value="Coverage.extension" />
      <sliceName value="Versichertenart" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://fhir.de/StructureDefinition/gkv/versichertenart" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x]">
      <path value="Coverage.extension.value[x]" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x].system">
      <path value="Coverage.extension.value[x].system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x].version">
      <path value="Coverage.extension.value[x].version" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x].code">
      <path value="Coverage.extension.value[x].code" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x].display">
      <path value="Coverage.extension.value[x].display" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:Versichertenart.value[x].userSelected">
      <path value="Coverage.extension.value[x].userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:WOP">
      <path value="Coverage.extension" />
      <sliceName value="WOP" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="http://fhir.de/StructureDefinition/gkv/wop" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:WOP.value[x]">
      <path value="Coverage.extension.value[x]" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:WOP.value[x].system">
      <path value="Coverage.extension.value[x].system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:WOP.value[x].version">
      <path value="Coverage.extension.value[x].version" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:WOP.value[x].code">
      <path value="Coverage.extension.value[x].code" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.extension:WOP.value[x].display">
      <path value="Coverage.extension.value[x].display" />
      <max value="0" />
    </element>
    <element id="Coverage.extension:WOP.value[x].userSelected">
      <path value="Coverage.extension.value[x].userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.identifier">
      <path value="Coverage.identifier" />
      <short value="Primaerer Identifier der Versicherung" />
      <definition value="Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet." />
      <max value="0" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.status">
      <path value="Coverage.status" />
      <fixedCode value="active" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.type">
      <path value="Coverage.type" />
      <short value="Kostenträgertyp" />
      <definition value="Art des Kostenträgers" />
      <min value="1" />
      <mustSupport value="true" />
      <binding>
        <strength value="required" />
        <valueSet value="https://fhir.kbv.de/ValueSet/KBV_VS_FOR_Payor_type" />
      </binding>
    </element>
    <element id="Coverage.type.coding">
      <path value="Coverage.type.coding" />
      <min value="1" />
      <max value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.type.coding.system">
      <path value="Coverage.type.coding.system" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.type.coding.version">
      <path value="Coverage.type.coding.version" />
      <max value="0" />
    </element>
    <element id="Coverage.type.coding.code">
      <path value="Coverage.type.coding.code" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.type.coding.display">
      <path value="Coverage.type.coding.display" />
      <max value="0" />
    </element>
    <element id="Coverage.type.coding.userSelected">
      <path value="Coverage.type.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.type.text">
      <path value="Coverage.type.text" />
      <max value="0" />
    </element>
    <element id="Coverage.policyHolder">
      <path value="Coverage.policyHolder" />
      <max value="0" />
    </element>
    <element id="Coverage.subscriber">
      <path value="Coverage.subscriber" />
      <max value="0" />
    </element>
    <element id="Coverage.subscriberId">
      <path value="Coverage.subscriberId" />
      <max value="0" />
    </element>
    <element id="Coverage.beneficiary">
      <path value="Coverage.beneficiary" />
      <short value="Begünstigte Person" />
      <type>
        <code value="Reference" />
        <targetProfile value="https://fhir.kbv.de/StructureDefinition/KBV_PR_FOR_Patient|1.3" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.beneficiary.reference">
      <path value="Coverage.beneficiary.reference" />
      <definition value="An dieser Stelle wird die Referenz zum Patienten hinterlegt." />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.beneficiary.type">
      <path value="Coverage.beneficiary.type" />
      <max value="0" />
    </element>
    <element id="Coverage.beneficiary.identifier">
      <path value="Coverage.beneficiary.identifier" />
      <max value="0" />
    </element>
    <element id="Coverage.beneficiary.display">
      <path value="Coverage.beneficiary.display" />
      <max value="0" />
    </element>
    <element id="Coverage.dependent">
      <path value="Coverage.dependent" />
      <max value="0" />
    </element>
    <element id="Coverage.relationship">
      <path value="Coverage.relationship" />
      <max value="0" />
    </element>
    <element id="Coverage.period">
      <path value="Coverage.period" />
      <constraint>
        <key value="-for-begrenzungDate" />
        <severity value="error" />
        <human value="Beschränkung auf die Angaben JJJJ-MM-TT" />
        <expression value="end.toString().length() = 10" />
      </constraint>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.period.start">
      <path value="Coverage.period.start" />
      <max value="0" />
    </element>
    <element id="Coverage.period.end">
      <path value="Coverage.period.end" />
      <short value="Versicherungsschutz Ende" />
      <definition value="Angabe zum Versicherungsschutz Ende" />
      <min value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor">
      <path value="Coverage.payor" />
      <max value="1" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.reference">
      <path value="Coverage.payor.reference" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.type">
      <path value="Coverage.payor.type" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier">
      <path value="Coverage.payor.identifier" />
      <short value="IKs" />
      <type>
        <code value="Identifier" />
        <profile value="http://fhir.de/StructureDefinition/identifier-iknr" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.extension">
      <path value="Coverage.payor.identifier.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <rules value="closed" />
      </slicing>
      <max value="1" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID">
      <path value="Coverage.payor.identifier.extension" />
      <sliceName value="alternativeID" />
      <max value="1" />
      <type>
        <code value="Extension" />
        <profile value="https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]">
      <path value="Coverage.payor.identifier.extension.value[x]" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier">
      <path value="Coverage.payor.identifier.extension.value[x]" />
      <sliceName value="valueIdentifier" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.use">
      <path value="Coverage.payor.identifier.extension.value[x].use" />
      <mustSupport value="false" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type">
      <path value="Coverage.payor.identifier.extension.value[x].type" />
      <mustSupport value="false" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding">
      <path value="Coverage.payor.identifier.extension.value[x].type.coding" />
      <mustSupport value="false" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.system">
      <path value="Coverage.payor.identifier.extension.value[x].type.coding.system" />
      <mustSupport value="false" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.type.coding.code">
      <path value="Coverage.payor.identifier.extension.value[x].type.coding.code" />
      <mustSupport value="false" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.system">
      <path value="Coverage.payor.identifier.extension.value[x].system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.extension:alternativeID.value[x]:valueIdentifier.value">
      <path value="Coverage.payor.identifier.extension.value[x].value" />
      <constraint>
        <key value="-for-laengeIK" />
        <severity value="error" />
        <human value="Die IK-Nummer muss 9-stellig numerisch sein." />
        <expression value="matches('^[0-9]{9,9}$')" />
      </constraint>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.type.coding.version">
      <path value="Coverage.payor.identifier.type.coding.version" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier.type.coding.display">
      <path value="Coverage.payor.identifier.type.coding.display" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier.type.coding.userSelected">
      <path value="Coverage.payor.identifier.type.coding.userSelected" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier.type.text">
      <path value="Coverage.payor.identifier.type.text" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier.system">
      <path value="Coverage.payor.identifier.system" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.value">
      <path value="Coverage.payor.identifier.value" />
      <constraint>
        <key value="-for-laengeIK" />
        <severity value="error" />
        <human value="Die IK-Nummer muss 9-stellig numerisch sein." />
        <expression value="matches('^[0-9]{9,9}$')" />
      </constraint>
      <mustSupport value="true" />
    </element>
    <element id="Coverage.payor.identifier.period">
      <path value="Coverage.payor.identifier.period" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.identifier.assigner">
      <path value="Coverage.payor.identifier.assigner" />
      <max value="0" />
    </element>
    <element id="Coverage.payor.display">
      <path value="Coverage.payor.display" />
      <short value="Kostenträgername" />
      <min value="1" />
      <maxLength value="45" />
      <mustSupport value="true" />
    </element>
    <element id="Coverage.class">
      <path value="Coverage.class" />
      <max value="0" />
    </element>
    <element id="Coverage.order">
      <path value="Coverage.order" />
      <max value="0" />
    </element>
    <element id="Coverage.network">
      <path value="Coverage.network" />
      <max value="0" />
    </element>
    <element id="Coverage.costToBeneficiary">
      <path value="Coverage.costToBeneficiary" />
      <max value="0" />
    </element>
    <element id="Coverage.subrogation">
      <path value="Coverage.subrogation" />
      <max value="0" />
    </element>
    <element id="Coverage.contract">
      <path value="Coverage.contract" />
      <max value="0" />
    </element>
  </differential>
</StructureDefinition>