Coverage-example.json

General Person Primary Coverage Example

{
  "resourceType": "Coverage",
  "id": "9876B1",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/certificate",
      "value": "12345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/v3/ActCode",
        "code": "EHCPOL",
        "display": "extended healthcare"
      }
    ]
  },
  "policyHolder": {
    "reference": "http://benefitsinc.com/FHIR/Organization/CBI35"
  },
  "subscriber": {
    "reference": "Patient/4"
  },
  "beneficiary": {
    "reference": "Patient/4"
  },
  "dependent": "0",
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "period": {
    "start": "2011-05-23",
    "end": "2012-05-23"
  },
  "payor": [
    {
      "reference": "Organization/2"
    }
  ],
  "class": [
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "group"
      },
      "value": "CB135",
      "name": "Corporate Baker's Inc. Local #35"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "subgroup"
      },
      "value": "123",
      "name": "Trainee Part-time Benefits"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "plan"
      },
      "value": "B37FC",
      "name": "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "subplan"
      },
      "value": "P7",
      "name": "Includes afterlife benefits"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "class"
      },
      "value": "SILVER",
      "name": "Silver: Family Plan spouse only"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "subclass"
      },
      "value": "Tier2",
      "name": "Low deductable, max $20 copay"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "sequence"
      },
      "value": "9"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "rxid"
      },
      "value": "MDF12345"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "rxbin"
      },
      "value": "987654"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "rxgroup"
      },
      "value": "M35PT"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "rxpcn"
      },
      "value": "234516"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-level",
        "code": "sequence"
      },
      "value": "9"
    }
  ]
}