臺灣核心實作指引(TW Core IG)
1.0.0 - STU 1.0.0 Taiwan flag

This page is part of the 臺灣核心實作指引(TW Core IG) (v1.0.0: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: TW Core Coverage

Official URL: https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Coverage-twcore Version: 1.0.0
Active as of 2025-12-10 Computable Name: TWCoreCoverage

此臺灣核心-給付範圍(TW Core Coverage) Profile 說明本 IG 如何進一步定義 FHIR 的 Coverage Resource 以呈現給付範圍資料。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... implicitRules ?!Σ 0..1 uri 本資源內容的處理規則
... modifierExtension ?! 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier SΣ 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SΣC 0..1 Identifier 會員 ID
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept 會員號碼識別碼類型
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... assigner Σ 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... type SΣ 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SΣC 0..1 string 被保險人 (訂閱者) ID
... beneficiary SΣ 1..1 Reference(TW Core Patient) 受益人
... relationship S 1..1 CodeableConcept 與被保險人關係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period 保險期間
... payor SΣ 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
..... value Σ 1..1 string Value associated with the type
.... class:group S 0..1 BackboneElement 群組
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 群組編號
..... name SΣ 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 計畫編號
..... name SΣ 0..1 string 計畫名稱

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:group.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... implicitRules 0..1 uri 本資源內容的處理規則
... modifierExtension 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier S 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SC 0..1 Identifier 會員 ID
..... type S 1..1 CodeableConcept 會員號碼識別碼類型
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
..... assigner 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... type S 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SC 0..1 string 被保險人 (訂閱者) ID
... beneficiary S 1..1 Reference(TW Core Patient) 受益人
... relationship S 1..1 CodeableConcept 與被保險人關係
... period S 0..1 Period 保險期間
... payor S 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:group S 0..1 BackboneElement 群組
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
..... value S 1..1 string 群組編號
..... name S 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
..... value S 1..1 string 計畫編號
..... name S 0..1 string 計畫名稱

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri 本資源內容的處理規則
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier SΣ 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SΣC 0..1 Identifier 會員 ID
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept 會員號碼識別碼類型
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SΣC 0..1 string 被保險人 (訂閱者) ID
... beneficiary SΣ 1..1 Reference(TW Core Patient) 受益人
... dependent Σ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept 與被保險人關係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period 保險期間
... payor SΣ 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:group S 0..1 BackboneElement 群組
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 群組編號
..... name SΣ 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 計畫編號
..... name SΣ 0..1 string 計畫名稱
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:group.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

This structure is derived from Coverage

Summary

Mandatory: 1 element(1 nested mandatory element)
Must-Support: 17 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.identifier
  • The element 1 is sliced based on the value of Coverage.class

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... implicitRules ?!Σ 0..1 uri 本資源內容的處理規則
... modifierExtension ?! 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier SΣ 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SΣC 0..1 Identifier 會員 ID
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept 會員號碼識別碼類型
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... assigner Σ 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... type SΣ 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SΣC 0..1 string 被保險人 (訂閱者) ID
... beneficiary SΣ 1..1 Reference(TW Core Patient) 受益人
... relationship S 1..1 CodeableConcept 與被保險人關係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period 保險期間
... payor SΣ 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
..... value Σ 1..1 string Value associated with the type
.... class:group S 0..1 BackboneElement 群組
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 群組編號
..... name SΣ 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 計畫編號
..... name SΣ 0..1 string 計畫名稱

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:group.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... implicitRules 0..1 uri 本資源內容的處理規則
... modifierExtension 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier S 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SC 0..1 Identifier 會員 ID
..... type S 1..1 CodeableConcept 會員號碼識別碼類型
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
..... assigner 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... type S 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SC 0..1 string 被保險人 (訂閱者) ID
... beneficiary S 1..1 Reference(TW Core Patient) 受益人
... relationship S 1..1 CodeableConcept 與被保險人關係
... period S 0..1 Period 保險期間
... payor S 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:group S 0..1 BackboneElement 群組
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
..... value S 1..1 string 群組編號
..... name S 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
..... value S 1..1 string 計畫編號
..... name S 0..1 string 計畫名稱

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage 保險、醫療計畫或付款協議
Constraints: tw-core-9
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri 本資源內容的處理規則
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension 擴充內容可能會改變資源解釋方式
... Slices for identifier SΣ 0..* Identifier 會員 ID 及其他識別碼
Slice: Unordered, Open by pattern:type
.... identifier:memberid SΣC 0..1 Identifier 會員 ID
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
..... type SΣ 1..1 CodeableConcept 會員號碼識別碼類型
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
... type SΣ 0..1 CodeableConcept 保險類型
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... policyHolder Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson | TW Core Organization) 保單持有人
... subscriber Σ 0..1 Reference(TW Core Patient | TW Core RelatedPerson) 被保險人 (訂閱者)
... subscriberId SΣC 0..1 string 被保險人 (訂閱者) ID
... beneficiary SΣ 1..1 Reference(TW Core Patient) 受益人
... dependent Σ 0..1 string Dependent number
... relationship S 1..1 CodeableConcept 與被保險人關係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period SΣ 0..1 Period 保險期間
... payor SΣ 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) 保險給付者
... Slices for class S 0..* BackboneElement 保險分類資訊
Slice: Unordered, Open by pattern:type
.... class:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
..... value Σ 1..1 string Value associated with the type
..... name Σ 0..1 string Human readable description of the type and value
.... class:group S 0..1 BackboneElement 群組
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 群組編號
..... name SΣ 0..1 string 群組名稱
.... class:plan S 0..1 BackboneElement 計畫
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... value SΣ 1..1 string 計畫編號
..... name SΣ 0..1 string 計畫名稱
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:memberid.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base extensible Coverage Type and Self-Pay Codes 📦4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:group.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.class:plan.​type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Coverage If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Coverage If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Coverage If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Coverage If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Coverage A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
tw-core-9 error Coverage Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

This structure is derived from Coverage

Summary

Mandatory: 1 element(1 nested mandatory element)
Must-Support: 17 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Coverage.identifier
  • The element 1 is sliced based on the value of Coverage.class

 

Other representations of profile: CSV, Excel, Schematron

Notes:

以下概述了此Profile所需的RESTful FHIR互動功能。有關TW Core IG支援的RESTful互動功能的完整清單，請參閱TW Core Server能力聲明。

必須支援以下查詢參數：

  1. 必須（SHALL） 支援透過查詢參數 patient 查詢所有Coverage：
    (如何透過reference查詢)
    GET [base]/Coverage?patient={Type/}[id]

    例子：
    (1) GET [base]/Coverage?patient=Patient/pat-example