This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON

: Dental Coverage Example1 - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "CoverageDental1",
  "meta" : {
    "lastUpdated" : "2021-01-01T14:22:01.0314215+00:00",
    "profile" : [
      🔗 "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.1.0-snapshot1"
    ]
  },
  "language" : "en-US",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage CoverageDental1</b></p><a name=\"CoverageDental1\"> </a><a name=\"hcCoverageDental1\"> </a><a name=\"CoverageDental1-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2021-01-01 14:22:01+0000; Language: en-US</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-C4BB-Coverage.html\">C4BB Coverageversion: {0}2.1.0-snapshot1)</a></p></div><p><b>identifier</b>: Member Number/210300002</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode DENTAL}\">dental care policy</span></p><p><b>policyHolder</b>: <a href=\"Patient-Patient2.html\">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.:\u00a088800933501)</a></p><p><b>subscriber</b>: <a href=\"Patient-Patient2.html\">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.:\u00a088800933501)</a></p><p><b>subscriberId</b>: 10300007</p><p><b>beneficiary</b>: <a href=\"Patient-Patient2.html\">Member 01 Test  Male, DoB: 1943-01-01 ( An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.:\u00a088800933501)</a></p><p><b>dependent</b>: 01</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2021-01-01 --&gt; 2021-12-31</p><p><b>payor</b>: <a href=\"Organization-DentalPayer1.html\">Organization INSURANCE COMPANY XYZ</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">An employee group</span></p><p><b>value</b>: 10300007</p><p><b>name</b>: Transcorp - dental</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: 66783JJT</p><p><b>name</b>: INSURANCE COMPANY XYZ - PRIME</p></blockquote><p><b>network</b>: INSURANCE COMPANY XYZ - PRIME</p></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "https://www.xxxhealthplan.com/fhir/memberidentifier",
      "value" : "210300002"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "DENTAL"
      }
    ],
    "text" : "dental care policy"
  },
  "policyHolder" : {
    🔗 "reference" : "Patient/Patient2"
  },
  "subscriber" : {
    🔗 "reference" : "Patient/Patient2"
  },
  "subscriberId" : "10300007",
  "beneficiary" : {
    🔗 "reference" : "Patient/Patient2"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2021-01-01",
    "end" : "2021-12-31"
  },
  "payor" : [
    {
      🔗 "reference" : "Organization/DentalPayer1"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "10300007",
      "name" : "Transcorp - dental"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ],
        "text" : "Plan"
      },
      "value" : "66783JJT",
      "name" : "INSURANCE COMPANY XYZ - PRIME"
    }
  ],
  "network" : "INSURANCE COMPANY XYZ - PRIME"
}