Self Payment Example

{
  "resourceType" : "Coverage",
  "id" : "SP1234",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a Self Pay Agreement.</div>"
  },
  "identifier" : [{
    "system" : "http://hospitalx.com/selfpayagreement",
    "value" : "SP12345678"
  }],
  "status" : "active",
  "kind" : "self-pay",
  "paymentBy" : [{
    "party" : {
      "reference" : "Patient/5"
    }
  }],
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
      "code" : "pay",
      "display" : "PAY"
    }]
  },
  "subscriber" : {
    "reference" : "Patient/5"
  },
  "beneficiary" : {
    "reference" : "Patient/5"
  },
  "relationship" : {
    "coding" : [{
      "code" : "self"
    }]
  },
  "period" : {
    "end" : "2012-03-17"
  }
}