General Person Primary Coverage Example

{
  "resourceType" : "Coverage",
  "id" : "9876B1",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "identifier" : [{
    "system" : "http://benefitsinc.com/certificate",
    "value" : "12345"
  }],
  "status" : "active",
  "kind" : "insurance",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code" : "EHCPOL",
      "display" : "extended healthcare"
    }]
  },
  "policyHolder" : {
    "reference" : "http://benefits.example.org/FHIR/Organization/CBI35"
  },
  "subscriber" : {
    "reference" : "Patient/4"
  },
  "beneficiary" : {
    "reference" : "Patient/4"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [{
      "code" : "self"
    }]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "insurer" : {
    "reference" : "Organization/2"
  },
  "class" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "group"
      }]
    },
    "value" : {
      "value" : "CB135"
    },
    "name" : "Corporate Baker's Inc. Local #35"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "subgroup"
      }]
    },
    "value" : {
      "value" : "123"
    },
    "name" : "Trainee Part-time Benefits"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "plan"
      }]
    },
    "value" : {
      "value" : "B37FC"
    },
    "name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "subplan"
      }]
    },
    "value" : {
      "value" : "P7"
    },
    "name" : "Includes afterlife benefits"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "class"
      }]
    },
    "value" : {
      "value" : "SILVER"
    },
    "name" : "Silver: Family Plan spouse only"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "subclass"
      }]
    },
    "value" : {
      "value" : "Tier2"
    },
    "name" : "Low deductable, max $20 copay"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "sequence"
      }]
    },
    "value" : {
      "value" : "9"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "rxid"
      }]
    },
    "value" : {
      "value" : "MDF12345"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "rxbin"
      }]
    },
    "value" : {
      "value" : "987654"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "rxgroup"
      }]
    },
    "value" : {
      "value" : "M35PT"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "rxpcn"
      }]
    },
    "value" : {
      "value" : "234516"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "sequence"
      }]
    },
    "value" : {
      "value" : "9"
    }
  }]
}