Release 5 Ballot
FinancialThis page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw Turtle (+ also see Turtle/RDF Format Specification)
General Person Primary Coverage with Benefit Details and new insurance
@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 -------------------------------------------------------------------
[a fhir:CoverageEligibilityResponse;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "E2502"];
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 CoverageEligibilityResponse.</div>"
];
fhir:DomainResource.contained [
a fhir:Coverage;
fhir:index 0;
fhir:Resource.id [ fhir:value "coverage-1" ];
fhir:Coverage.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
fhir:Identifier.value [ fhir:value "12345" ]
];
fhir:Coverage.status [ fhir:value "active" ];
fhir:Coverage.kind [ fhir:value "insurance" ];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "EHCPOL" ]
]
];
fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "Patient/f201" ]
];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "Patient/f201" ]
];
fhir:Coverage.dependent [ fhir:value "1" ];
fhir:Coverage.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "self" ]
]
];
fhir:Coverage.insurer [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
fhir:Identifier.value [ fhir:value "123456" ]
]
];
fhir:Coverage.class [
fhir:index 0;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
fhir:Coding.code [ fhir:value "EHCPOL" ]
]
];
fhir:Coverage.class.value [
fhir:Identifier.value [ fhir:value "CBI35" ]
];
fhir:Coverage.class.name [ fhir:value "Corporate Baker's Inc. Plan#35" ]
], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "subplan" ]
]
];
fhir:Coverage.class.value [
fhir:Identifier.value [ fhir:value "123" ]
];
fhir:Coverage.class.name [ fhir:value "Trainee Part-time Benefits" ]
], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
fhir:Coding.code [ fhir:value "sequence" ]
]
];
fhir:Coverage.class.value [
fhir:Identifier.value [ fhir:value "1" ]
]
]
];
fhir:CoverageEligibilityResponse.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse" ];
fhir:Identifier.value [ fhir:value "8812342" ]
];
fhir:CoverageEligibilityResponse.status [ fhir:value "active"];
fhir:CoverageEligibilityResponse.purpose [
fhir:value "validation";
fhir:index 0
], [
fhir:value "benefits";
fhir:index 1
];
fhir:CoverageEligibilityResponse.patient [
fhir:Reference.reference [ fhir:value "Patient/f201" ]
];
fhir:CoverageEligibilityResponse.created [ fhir:value "2014-09-16"^^xsd:date];
fhir:CoverageEligibilityResponse.requestor [
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://national.org/clinic" ];
fhir:Identifier.value [ fhir:value "OR1234" ]
]
];
fhir:CoverageEligibilityResponse.request [
fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405>;
fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405" ]
];
fhir:CoverageEligibilityResponse.outcome [ fhir:value "complete"];
fhir:CoverageEligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
fhir:CoverageEligibilityResponse.insurer [
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:CoverageEligibilityResponse.insurance [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.coverage [
fhir:Reference.reference [ fhir:value "#coverage-1" ]
];
fhir:CoverageEligibilityResponse.insurance.inforce [ fhir:value "true"^^xsd:boolean ];
fhir:CoverageEligibilityResponse.insurance.item [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
fhir:Coding.code [ fhir:value "30" ];
fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "500000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
fhir:Money.value [ fhir:value "3748.00"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-maximum" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "100"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "copay-percent" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
]
], [
fhir:index 1;
fhir:CoverageEligibilityResponse.insurance.item.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
fhir:Coding.code [ fhir:value "69" ];
fhir:Coding.display [ fhir:value "Maternity" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "15000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
], [
fhir:index 2;
fhir:CoverageEligibilityResponse.insurance.item.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
fhir:Coding.code [ fhir:value "F3" ];
fhir:Coding.display [ fhir:value "Dental Coverage" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.network [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
fhir:Coding.code [ fhir:value "in" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.unit [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
fhir:Coding.code [ fhir:value "individual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.term [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
fhir:Coding.code [ fhir:value "annual" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit [
fhir:index 0;
fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "benefit" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
fhir:Money.value [ fhir:value "2000"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ]
]
]
], [
fhir:index 3;
fhir:CoverageEligibilityResponse.insurance.item.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
fhir:Coding.code [ fhir:value "F6" ];
fhir:Coding.display [ fhir:value "Vision Coverage" ]
]
];
fhir:CoverageEligibilityResponse.insurance.item.excluded [ fhir:value "true"^^xsd:boolean ];
fhir:CoverageEligibilityResponse.insurance.item.name [ fhir:value "Vision" ];
fhir:CoverageEligibilityResponse.insurance.item.description [ fhir:value "Vision products and services such as exams, glasses and contact lenses." ]
]
];
fhir:CoverageEligibilityResponse.form [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://national.org/form" ];
fhir:Coding.code [ fhir:value "ELRSP/2017/01" ]
]
]] .
# - ontology header ------------------------------------------------------------
[a owl:Ontology;
owl:imports fhir:fhir.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.
FHIR ®© HL7.org 2011+. FHIR R5 Ballot hl7.fhir.core#5.0.0-ballot generated on Sat, Sep 10, 2022 05:02+1000.
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