General Person Primary Coverage with Benefit Details

{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "E2501",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  },
  "identifier" : [{
    "system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
    "value" : "881234"
  }],
  "status" : "active",
  "purpose" : ["validation",
  "benefits"],
  "patient" : {
    "reference" : "Patient/pat1"
  },
  "servicedDate" : "2014-09-17",
  "created" : "2014-08-16",
  "request" : {
    "reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"
  },
  "outcome" : "complete",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    "reference" : "Organization/2"
  },
  "insurance" : [{
    "coverage" : {
      "reference" : "Coverage/9876B1"
    },
    "inforce" : true,
    "item" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
          "code" : "30",
          "display" : "Health Benefit Plan Coverage"
        }]
      },
      "network" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
          "code" : "in"
        }]
      },
      "unit" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
          "code" : "individual"
        }]
      },
      "term" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
          "code" : "annual"
        }]
      },
      "benefit" : [{
        "type" : {
          "coding" : [{
            "code" : "benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 500000,
          "currency" : "SAR"
        }
      },
      {
        "type" : {
          "coding" : [{
            "code" : "copay-maximum"
          }]
        },
        "allowedMoney" : {
          "value" : 100,
          "currency" : "SAR"
        }
      },
      {
        "type" : {
          "coding" : [{
            "code" : "copay-percent"
          }]
        },
        "allowedUnsignedInt" : 20
      }]
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
          "code" : "69",
          "display" : "Maternity"
        }]
      },
      "network" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
          "code" : "in"
        }]
      },
      "unit" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
          "code" : "individual"
        }]
      },
      "term" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
          "code" : "annual"
        }]
      },
      "benefit" : [{
        "type" : {
          "coding" : [{
            "code" : "benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 15000,
          "currency" : "SAR"
        }
      }]
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
          "code" : "F3",
          "display" : "Dental Coverage"
        }]
      },
      "network" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
          "code" : "in"
        }]
      },
      "unit" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
          "code" : "individual"
        }]
      },
      "term" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
          "code" : "annual"
        }]
      },
      "benefit" : [{
        "type" : {
          "coding" : [{
            "code" : "benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 2000,
          "currency" : "SAR"
        }
      }]
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
          "code" : "F6",
          "display" : "Vision Coverage"
        }]
      },
      "network" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
          "code" : "in"
        }]
      },
      "unit" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
          "code" : "individual"
        }]
      },
      "term" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
          "code" : "annual"
        }]
      },
      "benefit" : [{
        "type" : {
          "coding" : [{
            "code" : "benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 400,
          "currency" : "SAR"
        }
      }]
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
          "code" : "49",
          "display" : "Hospital Room and Board"
        }]
      },
      "network" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
          "code" : "in"
        }]
      },
      "unit" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
          "code" : "individual"
        }]
      },
      "term" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
          "code" : "day"
        }]
      },
      "benefit" : [{
        "type" : {
          "coding" : [{
            "code" : "room"
          }]
        },
        "allowedString" : "shared"
      },
      {
        "type" : {
          "coding" : [{
            "code" : "benefit"
          }]
        },
        "allowedMoney" : {
          "value" : 600,
          "currency" : "SAR"
        }
      }]
    }]
  }]
}