Coverage resource (FHIR R4)

Coverage is the FHIR R4 resource for financial instrument which may be used to reimburse or pay for health care products and services.

Example

{
  "resourceType": "Coverage",
  "id": "coverage-e8c21a8da7c1d9832816a999ad7c518f",
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "HIP",
        "display": "health insurance plan policy"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/patient-L46A6EIB9J",
    "display": "Fuentes, Ola"
  },
  "subscriberId": "UHC-823978447",
  "beneficiary": {
    "reference": "Patient/patient-L46A6EIB9J"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self",
        "display": "Self"
      }
    ]
  },
  "period": {
    "start": "2025-07-01",
    "end": "2027-07-01"
  },
  "payor": [
    {
      "display": "UnitedHealthcare"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "group"
          }
        ]
      },
      "value": "GRP-45405",
      "name": "UnitedHealthcare Group Plan"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan"
          }
        ]
  ...

Generated by the Pidgeon engine: pidgeon generate Coverage --seed 20260722. Truncated for display; the command reproduces the full resource.

Validation context

• strict pidgeon validate grades a Coverage instance against the base R4 structure definition: missing required elements raise REQUIRED_FIELD_MISSING and cardinality violations raise CARDINALITY_MIN or CARDINALITY_MAX.(REQUIRED_FIELD_MISSING)
• strict Profile validation grades the same instance against an installed IG profile: profile cardinality findings carry FHIR-PROFILE-CARDINALITY and terminology binding findings carry FHIR-PROFILE-BINDING.(FHIR-PROFILE-CARDINALITY)