Coverage

A specific coverage section within a policy. Each coverage defines the limits, deductibles, and terms for a particular line of business or coverage part (e.g., General Liability, Property, Auto).

Structure

Name	Card.	Type	Description
RCoverage			A specific coverage section within a policy.
●resourceType	1..1	"Coverage"	Fixed resource type discriminator
●id	0..1	string	Logical id of this resource.
●meta	0..1	Meta	Metadata about the resource
●status	1..1	active | inactive | pending	Whether this coverage is currently active
●policy	1..1	Reference	Reference to the parent policy
●lineOfBusiness	1..1	CodeableConcept	Line of business for this coverage (GL, Property, WC, Auto, etc.) terminology
[ ]limits	0..*	CoverageLimit	Coverage limits
●deductible	0..1	Deductible	Structured deductible definition
●premium	0..1	Premium	Structured premium definition
[ ]coverageExtensions	0..*	CoverageExtension	Specific coverage features or extensions
[ ]classifications	0..*	Classification	Locations or classes covered under this section
●coinsurancePercentage	0..1	number	Coinsurance percentage, if applicable
[ ]risks	0..*	Reference	References to Risk resources covered under this coverage section
●specialty	0..1	InsuranceSpecialty	Insurance specialty / line-of-business detail for this coverage
●coveragePart	0..1	CodeableConcept	Coverage part identifier (e.g., HO: A=Dwelling, B=Other Structures, C=Personal Property, D=Loss of Use, E=Personal Liability, F=Medical Payments). terminology
[ ]scheduledItems	0..*	ScheduledItem	Scheduled personal property items under this coverage
[ ]exclusions	0..*	Exclusion	Exclusions applicable to this coverage
[ ]conditions	0..*	PolicyCondition	Conditions, warranties, and protective safeguard requirements
[ ]forms	0..*	InsuranceForm	Standard form references applicable to this coverage

Example

{
  "resourceType": "Coverage",
  "id": "cov-gl-001",
  "status": "active",
  "policy": {
    "reference": "Policy/pol-2025-1001"
  },
  "lineOfBusiness": {
    "coding": [
      {
        "code": "GL",
        "display": "General Liability"
      }
    ]
  },
  "limits": [
    {
      "type": {
        "text": "Each Occurrence"
      },
      "amount": {
        "value": 1000000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "text": "General Aggregate"
      },
      "amount": {
        "value": 2000000,
        "currency": "USD"
      }
    }
  ],
  "deductible": {
    "value": 5000,
    "currency": "USD"
  },
  "premium": {
    "value": 42000,
    "currency": "USD"
  }
}

JSON Schema

Full JSON Schema: Coverage.schema.json