Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id		0..1	id	Identificador lógico ou físico
meta		0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules		0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
Slices for identifier		1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA		0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador
use		0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type		0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
coding		1..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: NI
system		1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value		1..1	string	Número do Documento
period		0..1	Period	Período de validade do Identificador
assigner		0..1	Reference(Organization)	Entidade que emitiu o Identificador
status		1..1	code	O status da cobertura
type		0..1	CodeableConcept	Tipo de cobertura
policyHolder		1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber		0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId		0..1	string	Número da carteira do plano do beneficiário
beneficiary		1..1	Reference(Paciente)	O beneficiário da apólice
dependent		0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano
period		0..1	Period	Período de vigência da cobertura
payor		1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
type		1..1	CodeableConcept	Se o tipo de cobertura é grupo ou plano
value		1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name		0..1	string	O nome do plano
order		0..1	positiveInt	A ordem de cobertura
network		0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
type		0..1	CodeableConcept	O tipo de custo para o paciente
value[x]		1..1	SimpleQuantity, Money	O valor do custo para o paciente
exception		0..*	BackboneElement	Exceções ao custo para o paciente
type		1..1	CodeableConcept	O tipo de exceção ao custo para o paciente
period		0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id	Σ	0..1	id	Identificador lógico ou físico
meta	Σ	0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules	?!Σ	0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA	Σ	0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type	Σ	0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..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..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NI
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
system	Σ	1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value	Σ	1..1	string	Número do Documento Example General: 123456
period	Σ	0..1	Period	Período de validade do Identificador
assigner	Σ	0..1	Reference(Organization)	Entidade que emitiu o Identificador
status	?!Σ	1..1	code	O status da cobertura Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Tipo de cobertura Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber	Σ	0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId	Σ	0..1	string	Número da carteira do plano do beneficiário
beneficiary	Σ	1..1	Reference(Paciente)	O beneficiário da apólice
dependent	Σ	0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Período de vigência da cobertura
payor	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Se o tipo de cobertura é grupo ou plano Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name	Σ	0..1	string	O nome do plano
order	Σ	0..1	positiveInt	A ordem de cobertura
network	Σ	0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	O tipo de custo para o paciente Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		O valor do custo para o paciente
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceções ao custo para o paciente
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	O tipo de exceção ao custo para o paciente Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id	Σ	0..1	id	Identificador lógico ou físico
meta	Σ	0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules	?!Σ	0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA	Σ	0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type	Σ	0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..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..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NI
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
system	Σ	1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value	Σ	1..1	string	Número do Documento Example General: 123456
period	Σ	0..1	Period	Período de validade do Identificador
assigner	Σ	0..1	Reference(Organization)	Entidade que emitiu o Identificador
status	?!Σ	1..1	code	O status da cobertura Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Tipo de cobertura Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber	Σ	0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId	Σ	0..1	string	Número da carteira do plano do beneficiário
beneficiary	Σ	1..1	Reference(Paciente)	O beneficiário da apólice
dependent	Σ	0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Período de vigência da cobertura
payor	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
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	Se o tipo de cobertura é grupo ou plano Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name	Σ	0..1	string	O nome do plano
order	Σ	0..1	positiveInt	A ordem de cobertura
network	Σ	0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
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	O tipo de custo para o paciente Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		O valor do custo para o paciente
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceções ao custo para o paciente
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	O tipo de exceção ao custo para o paciente Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Summary

Mandatory: 5 elements (2 nested mandatory elements)
Fixed Value: 3 elements

Structures

This structure refers to these other structures:

• Operadora de plano privado de assistência à saúde (https://fhir.ans.gov.br/StructureDefinition/operadora)
• Paciente (https://fhir.ans.gov.br/StructureDefinition/paciente)

Slices

This structure defines the following Slices:

• The element Coverage.identifier is sliced based on the value of value:system

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id		0..1	id	Identificador lógico ou físico
meta		0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules		0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
Slices for identifier		1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA		0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador
use		0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type		0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
coding		1..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: NI
system		1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value		1..1	string	Número do Documento
period		0..1	Period	Período de validade do Identificador
assigner		0..1	Reference(Organization)	Entidade que emitiu o Identificador
status		1..1	code	O status da cobertura
type		0..1	CodeableConcept	Tipo de cobertura
policyHolder		1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber		0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId		0..1	string	Número da carteira do plano do beneficiário
beneficiary		1..1	Reference(Paciente)	O beneficiário da apólice
dependent		0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano
period		0..1	Period	Período de vigência da cobertura
payor		1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
type		1..1	CodeableConcept	Se o tipo de cobertura é grupo ou plano
value		1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name		0..1	string	O nome do plano
order		0..1	positiveInt	A ordem de cobertura
network		0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
type		0..1	CodeableConcept	O tipo de custo para o paciente
value[x]		1..1	SimpleQuantity, Money	O valor do custo para o paciente
exception		0..*	BackboneElement	Exceções ao custo para o paciente
type		1..1	CodeableConcept	O tipo de exceção ao custo para o paciente
period		0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id	Σ	0..1	id	Identificador lógico ou físico
meta	Σ	0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules	?!Σ	0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA	Σ	0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type	Σ	0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..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..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NI
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
system	Σ	1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value	Σ	1..1	string	Número do Documento Example General: 123456
period	Σ	0..1	Period	Período de validade do Identificador
assigner	Σ	0..1	Reference(Organization)	Entidade que emitiu o Identificador
status	?!Σ	1..1	code	O status da cobertura Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Tipo de cobertura Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber	Σ	0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId	Σ	0..1	string	Número da carteira do plano do beneficiário
beneficiary	Σ	1..1	Reference(Paciente)	O beneficiário da apólice
dependent	Σ	0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Período de vigência da cobertura
payor	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	Se o tipo de cobertura é grupo ou plano Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name	Σ	0..1	string	O nome do plano
order	Σ	0..1	positiveInt	A ordem de cobertura
network	Σ	0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	0..1	CodeableConcept	O tipo de custo para o paciente Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		O valor do custo para o paciente
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceções ao custo para o paciente
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	Σ	1..1	CodeableConcept	O tipo de exceção ao custo para o paciente Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Cobertura
id	Σ	0..1	id	Identificador lógico ou físico
meta	Σ	0..1	Meta	Elemento de metadados para identificações adicionais
implicitRules	?!Σ	0..1	uri	Regras implícitas deste perfil
language		0..1	code	Conceito codificável que classifica o idioma deste conjunto de guias Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Texto livre que descreve a história deste conjunto de guias de forma legível para seres humanos
contained		0..*	Resource	Outras informações que não existem por si só e só existem por dependência da existência desse conjunto de guias
extension		0..*	Extension	Conjunto de campos adicionais que são extensões ao modelo de informação
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	1..*	Identifier	Identificador da Cobertura Slice: Unordered, Open by value:system
identifier:rpsSCPA	Σ	0..1	Identifier	CPF da Cobertura
id		0..1	string	Identificador lógico do Identificador
extension		0..*	Extension	Extensões do Identificador Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	Uso do Identificador Binding: IdentifierUse (required): Qualifica o uso deste identificador Fixed Value: official
type	Σ	0..1	CodeableConcept	Tipo de Identificador Binding: Identifier Type Codes (extensible): Qualifica o tipo deste identificador Fixed Value: As shown (National unique individual identifier)
id		0..0	string	Unique id for inter-element referencing
extension		0..0	Extension	Additional content defined by implementations
coding		1..1	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..0	string	Unique id for inter-element referencing
extension		0..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..0	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: NI
display		0..0	string	Representation defined by the system
userSelected		0..0	boolean	If this coding was chosen directly by the user
text		0..0	string	Plain text representation of the concept
system	Σ	1..1	uri	Sistema de Identificação Fixed Value: https://fhir.ans.gov.br/sid/registro-rps-scpa
value	Σ	1..1	string	Número do Documento Example General: 123456
period	Σ	0..1	Period	Período de validade do Identificador
assigner	Σ	0..1	Reference(Organization)	Entidade que emitiu o Identificador
status	?!Σ	1..1	code	O status da cobertura Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Tipo de cobertura Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	O proprietário da apólice
subscriber	Σ	0..1	Reference(Paciente)	O usuário/beneficiário do plano
subscriberId	Σ	0..1	string	Número da carteira do plano do beneficiário
beneficiary	Σ	1..1	Reference(Paciente)	O beneficiário da apólice
dependent	Σ	0..1	string	O número da carteira do dependente
relationship		0..1	CodeableConcept	O relacionamento da Cobertura com o titular do plano Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period	Σ	0..1	Period	Período de vigência da cobertura
payor	Σ	1..1	Reference(Operadora de plano privado de assistência à saúde)	A operadora de saúde
class		0..*	BackboneElement	A classe de cobertura
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	Se o tipo de cobertura é grupo ou plano Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
value	Σ	1..1	string	O código de identificação utilizado pela operadora para este tipo de plano
name	Σ	0..1	string	O nome do plano
order	Σ	0..1	positiveInt	A ordem de cobertura
network	Σ	0..1	string	A rede de cobertura
costToBeneficiary		0..*	BackboneElement	O custo para o paciente
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	O tipo de custo para o paciente Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x]	Σ	1..1		O valor do custo para o paciente
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception		0..*	BackboneElement	Exceções ao custo para o paciente
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	O tipo de exceção ao custo para o paciente Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
period	Σ	0..1	Period	O período de exceção ao custo para o paciente
subrogation		0..1	boolean	A sub-rogação da cobertura
contract		0..*	Reference(Contract)	O contrato
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Coverage.identifier:rpsSCPA.use	required	Fixed Value: official
Coverage.identifier:rpsSCPA.type	extensible	Fixed Value: NI
Coverage.status	required	FinancialResourceStatusCodes
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes
Coverage.relationship	extensible	SubscriberRelationshipCodes
Coverage.class.type	extensible	CoverageClassCodes
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path(s)	Details	Requirements
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()

Summary

Mandatory: 5 elements (2 nested mandatory elements)
Fixed Value: 3 elements

Structures

This structure refers to these other structures:

• Operadora de plano privado de assistência à saúde (https://fhir.ans.gov.br/StructureDefinition/operadora)
• Paciente (https://fhir.ans.gov.br/StructureDefinition/paciente)

Slices

This structure defines the following Slices:

• The element Coverage.identifier is sliced based on the value of value:system