R6 Ballot (2nd Draft)
FinancialThis page is part of the FHIR Specification v6.0.0-ballot2: Release 6 Ballot (2nd Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
Raw Turtle (+ also see Turtle/RDF Format Specification)
General Person Primary Coverage with Benefit Details and new insurance
@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:CoverageEligibilityResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "E2502"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
] ; #
fhir:contained ( [
a fhir:Coverage ;
fhir:id [ fhir:v "coverage-1" ] ;
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:subscriber [
fhir:reference [ fhir:v "Patient/f201" ]
] ;
fhir:beneficiary [
fhir:reference [ fhir:v "Patient/f201" ]
] ;
fhir:dependent [ fhir:v "1" ] ;
fhir:relationship [
fhir:coding ( [
fhir:code [ fhir:v "self" ]
] )
] ;
fhir:insurer [
fhir:identifier [
fhir:system [ fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ] ;
fhir:value [ fhir:v "123456" ]
]
] ;
fhir:class ( [
fhir:type [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EHCPOL" ]
] )
] ;
fhir:value [
fhir:value [ fhir:v "CBI35" ]
] ;
fhir:name [ fhir:v "Corporate Baker's Inc. Plan#35" ]
] [
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 "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 "sequence" ]
] )
] ;
fhir:value [
fhir:value [ fhir:v "1" ]
]
] )
] ) ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"^^xsd:anyURI ] ;
fhir:value [ fhir:v "8812342" ]
] ) ; #
fhir:status [ fhir:v "active"] ; #
fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/f201" ]
] ; #
fhir:created [ fhir:v "2014-09-16"^^xsd:date] ; #
fhir:requestor [
fhir:identifier [
fhir:system [ fhir:v "http://national.org/clinic"^^xsd:anyURI ] ;
fhir:value [ fhir:v "OR1234" ]
]
] ; #
fhir:request [
fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405> ;
fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:disposition [ fhir:v "Policy is currently in-force."] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/2" ]
] ; #
fhir:insurance ( [
fhir:coverage [
fhir:reference [ fhir:v "#coverage-1" ]
] ;
fhir:inforce [ fhir:v "true"^^xsd:boolean ] ;
fhir:item ( [
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "30" ] ;
fhir:display [ fhir:v "Health Benefit Plan Coverage" ]
] )
] ;
fhir:network [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
fhir:code [ fhir:v "in" ]
] )
] ;
fhir:unit [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
fhir:code [ fhir:v "individual" ]
] )
] ;
fhir:term [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
fhir:code [ fhir:v "annual" ]
] )
] ;
fhir:benefit ( [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "benefit" ]
] )
] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "500000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:used [
a fhir:Money ;
fhir:value [ fhir:v "3748.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "copay-maximum" ]
] )
] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "copay-percent" ]
] )
] ;
fhir:allowed [ fhir:v "20"^^xsd:nonNegativeInteger ]
] )
] [
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "69" ] ;
fhir:display [ fhir:v "Maternity" ]
] )
] ;
fhir:network [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
fhir:code [ fhir:v "in" ]
] )
] ;
fhir:unit [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
fhir:code [ fhir:v "individual" ]
] )
] ;
fhir:term [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
fhir:code [ fhir:v "annual" ]
] )
] ;
fhir:benefit ( [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "benefit" ]
] )
] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "15000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] )
] [
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F3" ] ;
fhir:display [ fhir:v "Dental Coverage" ]
] )
] ;
fhir:network [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
fhir:code [ fhir:v "in" ]
] )
] ;
fhir:unit [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
fhir:code [ fhir:v "individual" ]
] )
] ;
fhir:term [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
fhir:code [ fhir:v "annual" ]
] )
] ;
fhir:benefit ( [
fhir:type [
fhir:coding ( [
fhir:code [ fhir:v "benefit" ]
] )
] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "2000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] )
] [
fhir:category [
fhir:coding ( [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
fhir:code [ fhir:v "F6" ] ;
fhir:display [ fhir:v "Vision Coverage" ]
] )
] ;
fhir:excluded [ fhir:v "true"^^xsd:boolean ] ;
fhir:name [ fhir:v "Vision" ] ; # this benefit category is not covered under the plan
fhir:description [ fhir:v "Vision products and services such as exams, glasses and contact lenses." ]
] )
] ) ; #
fhir:form [
fhir:coding ( [
fhir:system [ fhir:v "http://national.org/form"^^xsd:anyURI ] ;
fhir:code [ fhir:v "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 R6 hl7.fhir.core#6.0.0-ballot2 generated on Mon, Aug 12, 2024 16:58+0800.
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