This page is part of the CARIN Blue Button Implementation Guide (v2.0.0: STU 2) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON

: Coverage Example 1 - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="Coverage1"/>
  <meta>
    <lastUpdated value="2020-10-30T09:48:01.8462752-04:00"/>
    <profile
             value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.0.0"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p><b>Generated Narrative: Coverage</b><a name="Coverage1"> </a></p><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">Resource Coverage &quot;Coverage1&quot; Updated &quot;2020-10-30 09:48:01-0400&quot;  (Language &quot;en-US&quot;) </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-C4BB-Coverage.html">C4BB Coverage (version 2.0.0)</a></p></div><p><b>identifier</b>: An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier.: 88800933501</p><p><b>status</b>: active</p><p><b>policyHolder</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> &quot; EXAMPLE1&quot;</p><p><b>subscriber</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> &quot; EXAMPLE1&quot;</p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href="Patient-Patient1.html">Patient/Patient1</a> &quot; EXAMPLE1&quot;</p><p><b>dependent</b>: 01</p><p><b>relationship</b>: Self <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-subscriber-relationship.html">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href="Organization-Payer2.html">Organization/Payer2: UPMC Health Plan</a> &quot;UPMC Health Plan&quot;</p><blockquote><p><b>class</b></p><p><b>type</b>: An employee group <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#group &quot;Group&quot;)</span></p><p><b>value</b>: MCHMO1</p><p><b>name</b>: MEDICARE HMO PLAN</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: A specific suite of benefits. <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#plan &quot;Plan&quot;)</span></p><p><b>value</b>: GR5</p><p><b>name</b>: GR5-HMO DEDUCTIBLE</p></blockquote><p><b>network</b>: GR5-HMO DEDUCTIBLE</p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
      <text
            value="An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier."/>
    </type>
    <system value="https://www.upmchealthplan.com/fhir/memberidentifier"/>
    <value value="88800933501"/>
    <assigner>
      <reference value="Organization/Payer2"/>
      <display value="UPMC Health Plan"/>
    </assigner>
  </identifier>
  <status value="active"/>
  <policyHolder>
    <reference value="Patient/Patient1"/>
  </policyHolder>
  <subscriber>
    <reference value="Patient/Patient1"/>
  </subscriber>
  <subscriberId value="888009335"/>
  <beneficiary>
    <reference value="Patient/Patient1"/>
  </beneficiary>
  <dependent value="01"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
    <text value="Self"/>
  </relationship>
  <period>
    <start value="2020-01-01"/>
  </period>
  <payor>
    <reference value="Organization/Payer2"/>
    <display value="UPMC Health Plan"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
        <display value="Group"/>
      </coding>
      <text value="An employee group"/>
    </type>
    <value value="MCHMO1"/>
    <name value="MEDICARE HMO PLAN"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
        <display value="Plan"/>
      </coding>
      <text value="A specific suite of benefits."/>
    </type>
    <value value="GR5"/>
    <name value="GR5-HMO DEDUCTIBLE"/>
  </class>
  <network value="GR5-HMO DEDUCTIBLE"/>
</Coverage>