Coverage Vocabulary v1.0

Overview

Namespace URI:

https://ns.cascadeprotocol.org/coverage/v1#

Preferred Prefix:

coverage:

Version:

1.0

Status:

Stable

Schema File:

coverage.ttl (Turtle/RDF)

Layer:

2 (Domain Vocabulary)

The Coverage Vocabulary is a Layer 2 domain vocabulary for patient-owned insurance and benefits data. It resolves the overlap between checkup:InsuranceInfo (Layer 3, patient-reported) and clinical:CoverageRecord (Layer 2, EHR-imported) by providing a shared set of standardized insurance properties. Insurance data is cross-cutting: it is administrative and financial rather than clinical, it is not app-specific (any health app benefits from knowing a patient's coverage), and it is contributed by both patient self-report and EHR import. Any health app can use coverage: properties via the mixed namespace pattern.

Classes

Core Properties

These properties unify data from both patient-reported intake forms and EHR-imported coverage records. All properties have coverage:InsurancePlan as their domain.

Subscriber Properties

Properties for identifying the insurance subscriber (primary policyholder). All properties have coverage:InsurancePlan as their domain.

Pharmacy Benefit Properties

Properties for prescription drug benefit processing. All properties have coverage:InsurancePlan as their domain.

FHIR Alignment

The Coverage Vocabulary aligns with the FHIR Coverage resource. The following table maps each coverage: property to its corresponding FHIR path.

Coverage Property	FHIR Coverage Path
coverage:InsurancePlan	fhir:Coverage
coverage:providerName	Coverage.payor (display)
coverage:memberId	Coverage.identifier
coverage:groupNumber	Coverage.class (group)
coverage:planName	Coverage.class (plan)
coverage:planType	Coverage.type
coverage:coverageType	Coverage.class (category)
coverage:effectiveStart	Coverage.period.start
coverage:effectiveEnd	Coverage.period.end
coverage:subscriberId	Coverage.subscriberId
coverage:subscriberRelationship	Coverage.relationship

Usage Example

@prefix coverage: <https://ns.cascadeprotocol.org/coverage/v1#> .
@prefix cascade: <https://ns.cascadeprotocol.org/core/v1#> .
@prefix prov: <http://www.w3.org/ns/prov#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

<#insurance-primary> a coverage:InsurancePlan ;
    cascade:schemaVersion "1.0" ;
    cascade:dataProvenance cascade:SelfReported ;
    coverage:providerName "Blue Cross Blue Shield" ;
    coverage:memberId "XYZ123456789" ;
    coverage:groupNumber "GRP-98765" ;
    coverage:planType "ppo" ;
    coverage:coverageType "primary" ;
    coverage:effectiveStart "2026-01-01"^^xsd:date ;
    coverage:effectiveEnd "2026-12-31"^^xsd:date ;
    coverage:subscriberRelationship "self" .

Recommended Storage

The recommended Solid Pod storage layout for coverage data places insurance plans under a dedicated /coverage/ directory. Each plan is stored as its own Turtle file, enabling fine-grained access control and independent updates.

/coverage/
    plans/
        {plan-id}.ttl          # InsurancePlan instances
    deductibles/
        {year}.ttl             # Annual deductible tracking (future)

SHACL Validation Shapes

Validation shapes for this vocabulary are defined in coverage.shapes.ttl.

Shapes defined:

• coverage:InsurancePlanShape — Validates InsurancePlan instances with required provider name, member ID, plan type, and coverage type

Changelog

Version 1.0 (2026-02-18)

• Initial release with InsurancePlan class and 14 properties
  • 8 core properties: providerName, memberId, groupNumber, planName, planType, coverageType, effectiveStart, effectiveEnd
  • 3 subscriber properties: subscriberId, subscriberName, subscriberRelationship
  • 3 pharmacy benefit properties: rxBin, rxPcn, rxGroup
• Added Deductible and CopaySchedule classes (properties deferred to future version)
• FHIR Coverage resource alignment documented
• Part of Schema Refactoring Plan Phase 2 (WS4)