R4 Draft for Comment
FinancialThis page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Practitioner |
General Person Primary Coverage with Benefit Details
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/EligibilityResponse/E2501> a fhir:EligibilityResponse;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "E2501"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
];
fhir:EligibilityResponse.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/eligibilityresponse" ];
fhir:Identifier.value [ fhir:value "881234" ]
];
fhir:EligibilityResponse.status [ fhir:value "active"];
fhir:EligibilityResponse.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:EligibilityResponse.request [
fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332402>;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
];
fhir:EligibilityResponse.outcome [ fhir:value "complete"];
fhir:EligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
fhir:EligibilityResponse.insurer [
fhir:link <http://hl7.org/fhir/Organization/2>;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:EligibilityResponse.inforce [ fhir:value "true"^^xsd:boolean];
fhir:EligibilityResponse.insurance [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "medical" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "30" ];
fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "500000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
], [
fhir:index 1;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-maximum" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "100"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
], [
fhir:index 2;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-percent" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
]
], [
fhir:index 1;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "medical" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "69" ];
fhir:Coding.display [ fhir:value "Maternity" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "15000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
]
], [
fhir:index 2;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F3" ];
fhir:Coding.display [ fhir:value "Dental Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "2000"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
]
], [
fhir:index 3;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "vision" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "400"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
]
], [
fhir:index 4;
fhir:EligibilityResponse.insurance.benefitBalance.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
fhir:Coding.code [ fhir:value "vision" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
fhir:Coding.code [ fhir:value "49" ];
fhir:Coding.display [ fhir:value "Hospital Room and Board" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
fhir:Coding.code [ fhir:value "day" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial [
fhir:index 0;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "room" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedString [ fhir:value "shared" ]
], [
fhir:index 1;
fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
fhir:Quantity.value [ fhir:value "600"^^xsd:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "SAR" ]
]
]
]
] .
<http://hl7.org/fhir/Organization/2> a fhir:Organization .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/EligibilityResponse/E2501.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/EligibilityResponse/E2501.ttl> .
# -------------------------------------------------------------------------------------
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.
®© HL7.org 2011+. FHIR Release 4 Draft for Comment (Jan-2018 v3.2.0-12885) generated on Wed, Dec 20, 2017 15:57+1100. QA Page
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