This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions
General Person Primary Coverage with Benefit Details (id = "E2500")
<EligibilityResponse xmlns="http://hl7.org/fhir"> <id value="E2500"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the EligibilityResponse.</div> </text> <identifier> <system value="http://www.BenefitsInc.com/fhir/eligibilityresponse"/> <value value="881234"/> </identifier> <status value="active"/> <created value="2014-08-16"/> <request> <reference value="http://www.BenefitsInc.com/fhir/eligibility/225476332402"/> </request> <outcome> <coding> <system value="http://hl7.org/fhir/remittance-outcome"/> <code value="complete"/> </coding> </outcome> <disposition value="Policy is currently in-force."/> <insurer> <reference value="Organization/2"/> </insurer> <inforce value="true"/> <insurance> <benefitBalance> <category> <coding> <system value="http://hl7.org/fhir/benefit-category"/> <code value="medical"/> </coding> </category> <subCategory> <coding> <system value="http://hl7.org/fhir/benefit-subcategory"/> <code value="30"/> <display value="Health Benefit Plan Coverage"/> </coding> </subCategory> <network> <coding> <system value="http://hl7.org/fhir/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://hl7.org/fhir/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://hl7.org/fhir/benefit-term"/> <code value="annual"/> </coding> </term> <financial> <type> <coding> <code value="benefit"/> </coding> </type> <benefitMoney> <value value="500000"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> <financial> <type> <coding> <code value="copay-maximum"/> </coding> </type> <benefitMoney> <value value="100"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> <financial> <type> <coding> <code value="copay-percent"/> </coding> </type> <benefitUnsignedInt value="20"/> </financial> </benefitBalance> <benefitBalance> <category> <coding> <system value="http://hl7.org/fhir/benefit-category"/> <code value="medical"/> </coding> </category> <subCategory> <coding> <system value="http://hl7.org/fhir/benefit-subcategory"/> <code value="69"/> <display value="Maternity"/> </coding> </subCategory> <network> <coding> <system value="http://hl7.org/fhir/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://hl7.org/fhir/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://hl7.org/fhir/benefit-term"/> <code value="annual"/> </coding> </term> <financial> <type> <coding> <code value="benefit"/> </coding> </type> <benefitMoney> <value value="15000"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> </benefitBalance> <benefitBalance> <category> <coding> <system value="http://hl7.org/fhir/benefit-category"/> <code value="oral"/> </coding> </category> <subCategory> <coding> <system value="http://hl7.org/fhir/benefit-subcategory"/> <code value="F3"/> <display value="Dental Coverage"/> </coding> </subCategory> <network> <coding> <system value="http://hl7.org/fhir/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://hl7.org/fhir/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://hl7.org/fhir/benefit-term"/> <code value="annual"/> </coding> </term> <financial> <type> <coding> <code value="benefit"/> </coding> </type> <benefitMoney> <value value="2000"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> </benefitBalance> <benefitBalance> <category> <coding> <system value="http://hl7.org/fhir/benefit-category"/> <code value="vision"/> </coding> </category> <subCategory> <coding> <system value="http://hl7.org/fhir/benefit-subcategory"/> <code value="F6"/> <display value="Vision Coverage"/> </coding> </subCategory> <network> <coding> <system value="http://hl7.org/fhir/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://hl7.org/fhir/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://hl7.org/fhir/benefit-term"/> <code value="annual"/> </coding> </term> <financial> <type> <coding> <code value="benefit"/> </coding> </type> <benefitMoney> <value value="400"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> </benefitBalance> <benefitBalance> <category> <coding> <system value="http://hl7.org/fhir/benefit-category"/> <code value="vision"/> </coding> </category> <subCategory> <coding> <system value="http://hl7.org/fhir/benefit-subcategory"/> <code value="49"/> <display value="Hospital Room and Board"/> </coding> </subCategory> <network> <coding> <system value="http://hl7.org/fhir/benefit-network"/> <code value="in"/> </coding> </network> <unit> <coding> <system value="http://hl7.org/fhir/benefit-unit"/> <code value="individual"/> </coding> </unit> <term> <coding> <system value="http://hl7.org/fhir/benefit-term"/> <code value="day"/> </coding> </term> <financial> <type> <coding> <code value="room"/> </coding> </type> <benefitString value="shared"/> </financial> <financial> <type> <coding> <code value="benefit"/> </coding> </type> <benefitMoney> <value value="600"/> <system value="urn:iso:std:iso:4217"/> <code value="SAR"/> </benefitMoney> </financial> </benefitBalance> </insurance> </EligibilityResponse>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.