DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.1.0 - STU2.1 United States of America flag

This page is part of the US Drug Formulary (v2.1.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Coverage: InsurancePlanCoverageExample

Page standards status: Informative

Generated Narrative: Coverage InsurancePlanCoverageExample

Extension Definition for Coverage.insurancePlan for Version 5.0: InsurancePlan Sample Medicare Advantage Plan A1002

identifier: Member Number/88800933501

status: Active

type: PPO

subscriberId: 888009335

beneficiary: Amy V. Baxter Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))

relationship: Self

period: 2020-01-01 --> (ongoing)

payor: Acme Health Plan

class

type: An employee group

value: xyz

name: XYZ employee Group Plan

class

type: A specific suite of benefits.

value: gold

name: Acme Gold Plan