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
: InsurancePlanCoverageExample - TTL Representation
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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Coverage ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "InsurancePlanCoverageExample"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/insurance-plan-coverage"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/insurance-plan-coverage> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsurancePlanCoverageExample</b></p><a name=\"InsurancePlanCoverageExample\"> </a><a name=\"hcInsurancePlanCoverageExample\"> </a><a name=\"InsurancePlanCoverageExample-en-US\"> </a><p><b>Extension Definition for Coverage.insurancePlan for Version 5.0</b>: <a href=\"InsurancePlan-PayerInsurancePlanA1002.html\">InsurancePlan Sample Medicare Advantage Plan A1002</a></p><p><b>identifier</b>: Member Number/88800933501</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nahdo.org/sopt 3712}, {http://terminology.hl7.org/CodeSystem/v3-ActCode PPO}\">PPO</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Amy V. Baxter Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2020-01-01 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Acme Health Plan</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>: xyz</p><p><b>name</b>: XYZ employee Group Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">A specific suite of benefits.</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"^^rdf:XMLLiteral
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "InsurancePlan/PayerInsurancePlanA1002" ] ]
] ) ; #
fhir:identifier ( [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MB" ] ;
fhir:display [ fhir:v "Member Number" ] ] ) ] ;
fhir:system [ fhir:v "http://example.org/fhir/memberidentifier"^^xsd:anyURI ] ;
fhir:value [ fhir:v "88800933501" ]
] ) ; #
fhir:status [ fhir:v "active"] ; #
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "https://nahdo.org/sopt"^^xsd:anyURI ] ;
fhir:code [ fhir:v "3712" ] ;
fhir:display [ fhir:v "PPO" ] ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PPO" ] ;
fhir:display [ fhir:v "preferred provider organization policy" ] ] ) ;
fhir:text [ fhir:v "PPO" ]
] ; #
fhir:subscriberId [ fhir:v "888009335"] ; #
fhir:beneficiary [
fhir:reference [ fhir:v "Patient/example" ]
] ; #
fhir:relationship [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
fhir:code [ fhir:v "self" ] ] ) ;
fhir:text [ fhir:v "Self" ]
] ; #
fhir:period [
fhir:start [ fhir:v "2020-01-01"^^xsd:date ]
] ; #
fhir:payor ( [
fhir:reference [ fhir:v "Organization/acme-payer" ] ;
fhir:display [ fhir:v "Acme Health Plan" ]
] ) ; #
fhir:class ( [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "group" ] ;
fhir:display [ fhir:v "Group" ] ] ) ;
fhir:text [ fhir:v "An employee group" ] ] ;
fhir:value [ fhir:v "xyz" ] ;
fhir:name [ fhir:v "XYZ employee Group Plan" ]
] [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
fhir:code [ fhir:v "plan" ] ;
fhir:display [ fhir:v "Plan" ] ] ) ;
fhir:text [ fhir:v "A specific suite of benefits." ] ] ;
fhir:value [ fhir:v "gold" ] ;
fhir:name [ fhir:v "Acme Gold Plan" ]
] ) . #
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