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Coverage Entry

Your details
Name:
Country:

Note: all the rest of the fields are optional

FieldValue(s)Documentation
identifier #1System:
Value:
Type:
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependant
identifier #2System:
Value:
Type:
(repeat as needed)
identifier #3System:
Value:
Type:
statusThe status of the resource instance.
typeThe type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization
Policy HolderThe party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer.
SubscriberThe 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
SubscriberIdThe insurer assigned ID for the Subscriber.
BeneficiaryThe party who benefits from the insurance coverage., the patient when services are provided.
RelationshipThe relationship of beneficiary (patient) to the subscriber
PeriodStart:
End:
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 (use XML format YYYY-MM-DD)
PayorThe program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
Classifierscode + a short description for eachA suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan
GroupCode:
Display:
Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify an employer group. May also be referred to as a Policy or Group ID
Sub-GroupCode:
Display:
Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer group
PlanCode:
Display:
Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division ID
Sub-PlanCode:
Display:
Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employees
ClassCode:
Display:
Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-payment
Sub-ClassCode:
Display:
Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-payment
Additional Information
dependentA unique identifier for a dependent under the coverage
sequenceAn optional counter for a particular instance of the identified coverage which increments upon each renewal
orderThe order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of care
networkThe 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
Defined Extensions
Rx BIN number: Value: Type: string
Rx PCB number: Value: Type: string
Rx Group Code: Value: Type: string
Rx Member Id: Value: Type: string
Special Use Flag: Value: Type: code (pharma or non-pharma)
Other Extensions
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:
ExtensionURL:
Value: Type:

You can invent extension URLs to suit - just make them descriptive enough