Coverage-example.xml

General Person Primary Coverage Example (id = "9876B1")

<Coverage xmlns="http://hl7.org/fhir">
 <id value="9876B1"/> 

 <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</div> 
 </text> 
 
 <identifier> 
   <system value="http://benefitsinc.com/certificate"/> 
   <value value="12345"/> 
 </identifier> 

 <status value="active"/> 

 <type> 
  <coding> 
   <system value="http://hl7.org/fhir/v3/ActCode"/> 
   <code value="EHCPOL"/> 
   <display value="extended healthcare"/> 
  </coding> 
 </type> 
 
 <policyHolder> 
   <reference value="http://benefitsinc.com/FHIR/Organization/CBI35"/> 
 </policyHolder> 
 
 <subscriber> 
   <reference value="Patient/4"/> 
 </subscriber> 
 
 <beneficiary> 
   <reference value="Patient/4"/> 
 </beneficiary> 
 
 <relationship> 
  <coding> 
   <code value="self"/> 
  </coding> 
 </relationship> 

 <period>  
   <start value="2011-05-23"/> 
   <end value="2012-05-23"/> 
 </period> 
 
 <payor> 
   <reference value="Organization/2"/> 
 </payor> 
 
 <grouping> 
   <group value="CBI35"/> 
   <groupDisplay value="Corporate Baker's Inc. Local #35"/> 
   <subGroup value="123"/> 
   <subGroupDisplay value="Trainee Part-time Benefits"/> 
   <plan value="B37FC"/> 
   <planDisplay value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/> 
   <subPlan value="P7"/> 
   <subPlanDisplay value="Includes afterlife benefits"/> 
   <class value="SILVER"/> 
   <classDisplay value="Silver: Family Plan spouse only"/> 
   <subClass value="Tier2"/> 
   <subClassDisplay value="Low deductable, max $20 copay"/> 
 </grouping> 
  
 <dependent value="0"/> 
 <sequence value="9"/> 

</Coverage>