US Core Implementation Guide
6.1.0 - STU6 United States of America flag

This page is part of the US Core (v6.1.0: STU6 Update) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Coverage Example - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "coverage-example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"coverage-example\"> </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;coverage-example&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-us-core-coverage.html\">US Core Coverage Profile</a></p></div><p><b>identifier</b>: Member Number: 88800933501</p><p><b>status</b>: active</p><p><b>type</b>: PPO <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-SOPT.html\">Source of Payment Typology</a>#3712; <a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActCode.html\">ActCode</a>#PPO &quot;preferred provider organization policy&quot;)</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> &quot; SHAW&quot;</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/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-acme-payer.html\">Organization/acme-payer: Acme Health Plan</a> &quot;Acme 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/5.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group &quot;Group&quot;)</span></p><p><b>value</b>: xyz</p><p><b>name</b>: XYZ employee Group 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/5.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan &quot;Plan&quot;)</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ]
      },
      "system" : "http://example.org/fhir/memberidentifier",
      "value" : "88800933501"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "https://nahdo.org/sopt",
        "code" : "3712",
        "display" : "PPO"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "PPO",
        "display" : "preferred provider organization policy"
      }
    ],
    "text" : "PPO"
  },
  "subscriberId" : "888009335",
  "beneficiary" : {
    "reference" : "Patient/example"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ],
    "text" : "Self"
  },
  "period" : {
    "start" : "2020-01-01"
  },
  "payor" : [
    {
      "reference" : "Organization/acme-payer",
      "display" : "Acme Health Plan"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group",
            "display" : "Group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "xyz",
      "name" : "XYZ employee Group Plan"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ],
        "text" : "A specific suite of benefits."
      },
      "value" : "gold",
      "name" : "Acme Gold Plan"
    }
  ]
}