Coverage-example.xml

General Person Primary Coverage Example (id = "9876B1")

<Coverage xmlns="http://hl7.org/fhir">
 <id value="9876B1"/>

 <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</div>
 </text>
 
 <identifier>
   <system value="http://benefitsinc.com/certificate"/>
   <value value="12345"/>
 </identifier>

 <status value="active"/>

 <type>
  <coding>
   <system value="http://hl7.org/fhir/v3/ActCode"/>
   <code value="EHCPOL"/>
   <display value="extended healthcare"/>
  </coding>
 </type>
 
 <policyHolder>
   <reference value="http://benefitsinc.com/FHIR/Organization/CBI35"/>
 </policyHolder>
 
 <subscriber>
   <reference value="Patient/4"/>
 </subscriber>
 
 <beneficiary>
   <reference value="Patient/4"/>
 </beneficiary>
 
 <relationship>
  <coding>
   <code value="self"/>
  </coding>
 </relationship>

 <period> 
   <start value="2011-05-23"/>
   <end value="2012-05-23"/>
 </period>
 
 <payor>
   <reference value="Organization/2"/>
 </payor>
 
 <group>
   <group value="CBI35"/>
   <groupDisplay value="Corporate Baker's Inc. Local #35"/>
   <subGroup value="123"/>
   <subGroupDisplay value="Trainee Part-time Benefits"/>
   <plan value="B37FC"/>
   <planDisplay value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
   <subPlan value="P7"/>
   <subPlanDisplay value="Includes afterlife benefits"/>
   <class value="SILVER"/>
   <classDisplay value="Silver: Family Plan spouse only"/>
   <subClass value="Tier2"/>
   <subClassDisplay value="Low deductable, max $20 copay"/>
 </group>
  
 <dependent value="0"/>
 <sequence value="9"/>

</Coverage>