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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Patient, Practitioner |
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General Person Primary Coverage with Benefit Details
@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 "E2501"] ; # 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:identifier ( [ fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"^^xsd:anyURI ] ; fhir:value [ fhir:v "881234" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; # fhir:patient [ fhir:reference [ fhir:v "Patient/pat1" ] ] ; # fhir:serviced [ fhir:v "2014-09-17"^^xsd:date] ; # fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # Anticipated service date fhir:request [ fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402> ; fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402" ] ] ; # 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/9876B1" ] ] ; 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 "SAR" ] ] ] [ 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 "SAR" ] ] ] [ 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 "SAR" ] ] ] ) ] [ 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 "SAR" ] ] ] ) ] [ 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: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 "400"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] ) ] [ fhir:category [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ; fhir:code [ fhir:v "49" ] ; fhir:display [ fhir:v "Hospital Room and Board" ] ] ) ] ; 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 "day" ] ] ) ] ; fhir:benefit ( [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "room" ] ] ) ] ; fhir:allowed [ fhir:v "shared" ] ] [ fhir:type [ fhir:coding ( [ fhir:code [ fhir:v "benefit" ] ] ) ] ; fhir:allowed [ a fhir:Money ; fhir:value [ fhir:v "600"^^xsd:decimal ] ; fhir:currency [ fhir:v "SAR" ] ] ] ) ] ) ] )] . # # -------------------------------------------------------------------------------------
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 R5 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:24+1100.
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