General Person Secondary Coverage Example

{
  "resourceType" : "Coverage",
  "id" : "7546D",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "identifier" : [{
    "system" : "http://xyz.com/codes/identifier",
    "value" : "AB98761"
  }],
  "status" : "active",
  "kind" : "insurance",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code" : "EHCPOL",
      "display" : "extended healthcare"
    }]
  },
  "subscriber" : {
    "reference" : "Patient/5"
  },
  "subscriberId" : [{
    "value" : "AB9876"
  }],
  "beneficiary" : {
    "reference" : "Patient/5"
  },
  "dependent" : "1",
  "relationship" : {
    "coding" : [{
      "code" : "self"
    }]
  },
  "period" : {
    "start" : "2011-03-17",
    "end" : "2012-03-17"
  },
  "insurer" : {
    "reference" : "Organization/2"
  },
  "class" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "group"
      }]
    },
    "value" : {
      "value" : "WESTAIR"
    },
    "name" : "Western Airlines"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "plan"
      }]
    },
    "value" : {
      "value" : "BG4352"
    },
    "name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "subplan"
      }]
    },
    "value" : {
      "value" : "D15C9"
    },
    "name" : "Platinum"
  }],
  "order" : 2,
  "network" : "5",
  "costToBeneficiary" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
        "code" : "gpvisit"
      }]
    },
    "valueMoney" : {
      "value" : 20.00,
      "currency" : "USD"
    },
    "exception" : [{
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception",
          "code" : "retired"
        }]
      },
      "period" : {
        "start" : "2018-01-01",
        "end" : "2018-12-31"
      }
    }]
  }],
  "contract" : [{
    "reference" : "Contract/INS-101"
  }]
}