Release 5 Ballot
FinancialThis page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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 JSON (canonical form + also see JSON Format Specification)
General Person Primary Coverage with Benefit Details and new insurance
{
"resourceType": "CoverageEligibilityResponse",
"id": "E2502",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
},
"contained": [
{
"resourceType": "Coverage",
"id": "coverage-1",
"identifier": [
{
"system": "http://benefitsinc.com/certificate",
"value": "12345"
}
],
"status": "active",
"kind": "insurance",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "EHCPOL"
}
]
},
"subscriber": {
"reference": "Patient/f201"
},
"beneficiary": {
"reference": "Patient/f201"
},
"dependent": "1",
"relationship": {
"coding": [
{
"code": "self"
}
]
},
"insurer": {
"identifier": {
"system": "http://www.bindb.com/bin",
"value": "123456"
}
},
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "EHCPOL"
}
]
},
"value": {
"value": "CBI35"
},
"name": "Corporate Baker's Inc. Plan#35"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "subplan"
}
]
},
"value": {
"value": "123"
},
"name": "Trainee Part-time Benefits"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "sequence"
}
]
},
"value": {
"value": "1"
}
}
]
}
],
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value": "8812342"
}
],
"status": "active",
"purpose": [
"validation",
"benefits"
],
"patient": {
"reference": "Patient/f201"
},
"created": "2014-09-16",
"requestor": {
"identifier": {
"system": "http://national.org/clinic",
"value": "OR1234"
}
},
"request": {
"reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405"
},
"outcome": "complete",
"disposition": "Policy is currently in-force.",
"insurer": {
"reference": "Organization/2"
},
"insurance": [
{
"coverage": {
"reference": "#coverage-1"
},
"inforce": true,
"item": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "30",
"display": "Health Benefit Plan Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 500000,
"currency": "USD"
},
"usedMoney": {
"value": 3748.00,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"code": "copay-maximum"
}
]
},
"allowedMoney": {
"value": 100,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"code": "copay-percent"
}
]
},
"allowedUnsignedInt": 20
}
]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "69",
"display": "Maternity"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 15000,
"currency": "USD"
}
}
]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "F3",
"display": "Dental Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 2000,
"currency": "USD"
}
}
]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "F6",
"display": "Vision Coverage"
}
]
},
"excluded": true,
"name": "Vision",
"description": "Vision products and services such as exams, glasses and contact lenses."
}
]
}
],
"form": {
"coding": [
{
"system": "http://national.org/form",
"code": "ELRSP/2017/01"
}
]
}
}
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 Wed, Sep 7, 2022 11:07+1000.
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