This page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - 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 R3
Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, RelatedPerson |
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General Person Primary Coverage Example
@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:Coverage ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "9876B1"] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>" ] ; # fhir:identifier ( [ fhir:system [ fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ] ; fhir:value [ fhir:v "12345" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:kind [ fhir:v "insurance"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "EHCPOL" ] ; fhir:display [ fhir:v "extended healthcare" ] ] ) ] ; # fhir:policyHolder [ fhir:link <http://benefitsinc.com/FHIR/Organization/CBI35> ; fhir:reference [ fhir:v "http://benefitsinc.com/FHIR/Organization/CBI35" ] ] ; # fhir:subscriber [ fhir:reference [ fhir:v "Patient/4" ] ] ; # fhir:beneficiary [ fhir:reference [ fhir:v "Patient/4" ] ] ; # fhir:dependent [ fhir:v "0"] ; # fhir:relationship [ fhir:coding ( [ fhir:code [ fhir:v "self" ] ] ) ] ; # fhir:period [ fhir:start [ fhir:v "2011-05-23"^^xsd:date ] ; fhir:end [ fhir:v "2012-05-23"^^xsd:date ] ] ; # fhir:insurer [ fhir:reference [ fhir:v "Organization/2" ] ] ; # fhir:class ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "group" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "CB135" ] ] ; fhir:name [ fhir:v "Corporate Baker's Inc. Local #35" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subgroup" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "123" ] ] ; fhir:name [ fhir:v "Trainee Part-time Benefits" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "B37FC" ] ] ; fhir:name [ fhir:v "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subplan" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "P7" ] ] ; fhir:name [ fhir:v "Includes afterlife benefits" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "class" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "SILVER" ] ] ; fhir:name [ fhir:v "Silver: Family Plan spouse only" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "subclass" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "Tier2" ] ] ; fhir:name [ fhir:v "Low deductable, max $20 copay" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "sequence" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "9" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxid" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "MDF12345" ] ] # member id used when submitting pharmacy claims ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxbin" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "987654" ] ] # the pharmacy processor BIN number used when submitting pharmacy claims ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxgroup" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "M35PT" ] ] # group used when submitting pharmacy claims ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxpcn" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "234516" ] ] # the PCN number used when submitting pharmacy claims ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "sequence" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "9" ] ] # the sequence number for a short-term continuance of the coverage ] )] . # The repeating 'class' element is proposed to replace the 'grouping' element # -------------------------------------------------------------------------------------
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.
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