This page is part of the Da Vinci Clinical Documentation Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
JSON Format: Coverage-cdex-example-coverage
Raw json
{
"resourceType" : "Coverage",
"id" : "cdex-example-coverage",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-04-09T10:59:17.000-04:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage\n </div>"
},
"identifier" : [
{
"system" : "http://benefitsinc.com/certificate",
"value" : "12345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHCPOL",
"display" : "extended healthcare"
}
]
},
"subscriber" : {
"reference" : "Patient/cdex-example-patient"
},
"beneficiary" : {
"reference" : "Patient/cdex-example-patient"
},
"dependent" : "0",
"relationship" : {
"coding" : [
{
"code" : "self"
}
]
},
"period" : {
"start" : "2011-05-23",
"end" : "2012-05-23"
},
"payor" : [
{
"reference" : "Organization/cdex-example-payer"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "CB135",
"name" : "Corporate Baker's Inc. Local #35"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subgroup"
}
]
},
"value" : "123",
"name" : "Trainee Part-time Benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "B37FC",
"name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}
]
},
"value" : "P7",
"name" : "Includes afterlife benefits"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "class"
}
]
},
"value" : "SILVER",
"name" : "Silver: Family Plan spouse only"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subclass"
}
]
},
"value" : "Tier2",
"name" : "Low deductable, max $20 copay"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxid"
}
]
},
"value" : "MDF12345"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxbin"
}
]
},
"value" : "987654"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxgroup"
}
]
},
"value" : "M35PT"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxpcn"
}
]
},
"value" : "234516"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "sequence"
}
]
},
"value" : "9"
}
]
}
