CARIN Digital Insurance Card
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CARIN Digital Insurance Card - Downloaded Version 2.0.0-ballot See the Directory of published versions

## : Example-Coverage-FSH - TTL Representation

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

    <http://hl7.org/fhir/Coverage/Example-Coverage-FSH> a fhir:Coverage ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:Resource.id [ fhir:value "Example-Coverage-FSH"] ;
      fhir:Resource.meta [
         fhir:Meta.versionId [ fhir:value "1" ] ;
         fhir:Meta.lastUpdated [ fhir:value "2021-04-06T10:49:02.473+00:00"^^xsd:dateTime ] ;
         fhir:Meta.profile [
           fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage" ;
           fhir:index 0 ;
           fhir:link <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage>
         ]
      ] ;
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "extensions" ] ;
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage Example-Coverage-FSH</b></p><a name=\"Example-Coverage-FSH\"> </a><a name=\"hcExample-Coverage-FSH\"> </a><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\">version: 1; Last updated: 2021-04-06 10:49:02+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-C4DIC-Coverage.html\">C4DIC Coverage</a></p></div><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-01</li><li>name: John Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-02</li><li>name: jane Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-03</li><li>name: Jimmy Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-04</li><li>name: Ginny Doe </li></ul></blockquote><p><b>Additional Insurance Card Information</b>: </p><blockquote><div><p>If you use a TTY, call 711.\nYou may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law.\nWe encourage you to use a primary care physician as a valuable resource and personal health advocate.</p>\n</div></blockquote><p><b>Additional Insurance Card Information</b>: <a href=\"InsurancePlan-SBCExampleHMO.html\">Summary of Benefits and Coverage - Acme Gold Plus HMO</a></p><p><b>Card Issue Date</b>: 2020-12-15</p><blockquote><p><b>Color Palette</b></p><ul><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #00bfff}\">#00bfff</span></li><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #000000}\">#000000</span></li><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #ceebf5}\">#ceebf5</span></li></ul></blockquote><blockquote><p><b>Logo</b></p><ul><li>description: Company logo</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: ACME Inc.</li></ul></blockquote><blockquote><p><b>QR Code</b></p><ul><li>description: Usage text for this QR code for the end user</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: Some label for this QR code</li></ul></blockquote><blockquote><p><b>Barcode</b></p><ul><li>description: Usage text for this Barcode for the end user</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: Some label for this Barcode</li></ul></blockquote><blockquote><p><b>Supporting image</b></p><ul><li>description: Image of the front of the member's physical insurance card showing plan name, member ID, and group number</li><li>image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...</li><li>label: Front of insurance card</li></ul></blockquote><blockquote><p><b>Supporting image</b></p><ul><li>description: Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information</li><li>image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...</li><li>label: Back of insurance card</li></ul></blockquote><p><b>identifier</b>: Member Number/102345672-02</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Patient-Example-Patient1.html\">John Doe</a></p><p><b>subscriberId</b>: 102345672-01</p><p><b>beneficiary</b>: <a href=\"Patient-Example-Patient2.html\">Jane Doe</a></p><p><b>dependent</b>: 02</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship spouse}\">Spouse</span></p><p><b>period</b>: 2021-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-Example-PayerOrganization1.html\">Acme Insurance Co</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: 993355</p><p><b>name</b>: Stars Inc</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: 11461128</p><p><b>name</b>: Acme Gold Plus</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS division}\">Division</span></p><p><b>value</b>: 11</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS network}\">Network</span></p><p><b>value</b>: 561490</p><p><b>name</b>: Acme Gold Plus South</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}\">RX BIN</span></p><p><b>value</b>: 100045</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}\">RX PCN</span></p><p><b>value</b>: 1234000</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamOutDed}\">Family Out of Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$10,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamInDed}\">Family In Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$8,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxOutDed}\">Family Pharmacy Out of Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$2,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxInDed}\">Family Pharmacy In Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$1,500.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamOutMax}\">Family Out of Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$12,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamInMax}\">Family In Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$10,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxOutMax}\">Family Pharmacy Out of Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$3,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxInMax}\">Family Pharmacy In Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$2,000.00</span> (USD)</p></blockquote></div>"
      ] ;
      fhir:DomainResource.extension [
         fhir:index 0 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "memberId" ] ;
           fhir:Extension.valueString [ fhir:value "102345672-01" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "name" ] ;
           fhir:Extension.valueHumanName [
             fhir:HumanName.family [ fhir:value "Doe" ] ;
             fhir:HumanName.given [
               fhir:value "John" ;
               fhir:index 0
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
      ], [
         fhir:index 1 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "memberId" ] ;
           fhir:Extension.valueString [ fhir:value "102345672-02" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "name" ] ;
           fhir:Extension.valueHumanName [
             fhir:HumanName.family [ fhir:value "Doe" ] ;
             fhir:HumanName.given [
               fhir:value "jane" ;
               fhir:index 0
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
      ], [
         fhir:index 2 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "memberId" ] ;
           fhir:Extension.valueString [ fhir:value "102345672-03" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "name" ] ;
           fhir:Extension.valueHumanName [
             fhir:HumanName.family [ fhir:value "Doe" ] ;
             fhir:HumanName.given [
               fhir:value "Jimmy" ;
               fhir:index 0
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
      ], [
         fhir:index 3 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "memberId" ] ;
           fhir:Extension.valueString [ fhir:value "102345672-04" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "name" ] ;
           fhir:Extension.valueHumanName [
             fhir:HumanName.family [ fhir:value "Doe" ] ;
             fhir:HumanName.given [
               fhir:value "Ginny" ;
               fhir:index 0
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ]
      ], [
         fhir:index 4 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension" ] ;
         fhir:Extension.valueAnnotation [
           fhir:Annotation.text [ fhir:value "If you use a TTY, call 711.\nYou may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law.\nWe encourage you to use a primary care physician as a valuable resource and personal health advocate." ]
         ]
      ], [
         fhir:index 5 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension" ] ;
         fhir:Extension.valueReference [
           fhir:link <http://hl7.org/fhir/InsurancePlan/SBCExampleHMO> ;
           fhir:Reference.reference [ fhir:value "InsurancePlan/SBCExampleHMO" ] ;
           fhir:Reference.display [ fhir:value "Summary of Benefits and Coverage - Acme Gold Plus HMO" ]
         ]
      ], [
         fhir:index 6 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension" ] ;
         fhir:Extension.valueDate [ fhir:value "2020-12-15"^^xsd:date ]
      ], [
         fhir:index 7 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0 ;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ;
               fhir:Coding.code [ fhir:value "#00bfff" ]
             ]
           ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0 ;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ;
               fhir:Coding.code [ fhir:value "#000000" ]
             ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension" ] ;
           fhir:Extension.valueCodeableConcept [
             fhir:CodeableConcept.coding [
               fhir:index 0 ;
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ;
               fhir:Coding.code [ fhir:value "#ceebf5" ]
             ]
           ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension" ]
      ], [
         fhir:index 8 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "description" ] ;
           fhir:Extension.valueString [ fhir:value "Company logo" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "image" ] ;
           fhir:Extension.valueAttachment [
             fhir:Attachment.contentType [ fhir:value "image/png" ] ;
             fhir:Attachment.data [ fhir:value " "^^xsd:base64Binary ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "label" ] ;
           fhir:Extension.valueString [ fhir:value "ACME Inc." ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension" ]
      ], [
         fhir:index 9 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "description" ] ;
           fhir:Extension.valueString [ fhir:value "Usage text for this QR code for the end user" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "image" ] ;
           fhir:Extension.valueAttachment [
             fhir:Attachment.contentType [ fhir:value "image/png" ] ;
             fhir:Attachment.data [ fhir:value " "^^xsd:base64Binary ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "label" ] ;
           fhir:Extension.valueString [ fhir:value "Some label for this QR code" ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension" ]
      ], [
         fhir:index 10 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "description" ] ;
           fhir:Extension.valueString [ fhir:value "Usage text for this Barcode for the end user" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "image" ] ;
           fhir:Extension.valueAttachment [
             fhir:Attachment.contentType [ fhir:value "image/png" ] ;
             fhir:Attachment.data [ fhir:value " "^^xsd:base64Binary ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "label" ] ;
           fhir:Extension.valueString [ fhir:value "Some label for this Barcode" ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension" ]
      ], [
         fhir:index 11 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "description" ] ;
           fhir:Extension.valueString [ fhir:value "Image of the front of the member's physical insurance card showing plan name, member ID, and group number" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "image" ] ;
           fhir:Extension.valueAttachment [
             fhir:Attachment.contentType [ fhir:value "image/jpeg" ] ;
             fhir:Attachment.data [ fhir:value " "^^xsd:base64Binary ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "label" ] ;
           fhir:Extension.valueString [ fhir:value "Front of insurance card" ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension" ]
      ], [
         fhir:index 12 ;
         fhir:Element.extension [
           fhir:index 0 ;
           fhir:Extension.url [ fhir:value "description" ] ;
           fhir:Extension.valueString [ fhir:value "Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information" ]
         ], [
           fhir:index 1 ;
           fhir:Extension.url [ fhir:value "image" ] ;
           fhir:Extension.valueAttachment [
             fhir:Attachment.contentType [ fhir:value "image/jpeg" ] ;
             fhir:Attachment.data [ fhir:value " "^^xsd:base64Binary ]
           ]
         ], [
           fhir:index 2 ;
           fhir:Extension.url [ fhir:value "label" ] ;
           fhir:Extension.valueString [ fhir:value "Back of insurance card" ]
         ] ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension" ]
      ] ;
      fhir:Coverage.identifier [
         fhir:index 0 ;
         fhir:Identifier.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ] ;
             fhir:Coding.code [ fhir:value "MB" ] ;
             fhir:Coding.display [ fhir:value "Member Number" ]
           ]
         ] ;
         fhir:Identifier.system [ fhir:value "https://www.acmeinsurance.com/glossary/memberid" ] ;
         fhir:Identifier.value [ fhir:value "102345672-02" ] ;
         fhir:Identifier.assigner [
           fhir:Reference.display [ fhir:value "Acme Insurance Co" ]
         ]
      ] ;
      fhir:Coverage.status [ fhir:value "active"] ;
      fhir:Coverage.type [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ] ;
           fhir:Coding.code [ fhir:value "HIP" ] ;
           fhir:Coding.display [ fhir:value "health insurance plan policy" ]
         ] ;
         fhir:CodeableConcept.text [ fhir:value "health insurance plan policy" ]
      ] ;
      fhir:Coverage.subscriber [
         fhir:link <http://hl7.org/fhir/Patient/Example-Patient1> ;
         fhir:Reference.reference [ fhir:value "Patient/Example-Patient1" ] ;
         fhir:Reference.display [ fhir:value "John Doe" ]
      ] ;
      fhir:Coverage.subscriberId [ fhir:value "102345672-01"] ;
      fhir:Coverage.beneficiary [
         fhir:link <http://hl7.org/fhir/Patient/Example-Patient2> ;
         fhir:Reference.reference [ fhir:value "Patient/Example-Patient2" ] ;
         fhir:Reference.display [ fhir:value "Jane Doe" ]
      ] ;
      fhir:Coverage.dependent [ fhir:value "02"] ;
      fhir:Coverage.relationship [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ;
           fhir:Coding.code [ fhir:value "spouse" ] ;
           fhir:Coding.display [ fhir:value "Spouse" ]
         ] ;
         fhir:CodeableConcept.text [ fhir:value "Spouse" ]
      ] ;
      fhir:Coverage.period [
         fhir:Period.start [ fhir:value "2021-01-01"^^xsd:date ]
      ] ;
      fhir:Coverage.payor [
         fhir:index 0 ;
         fhir:link <http://hl7.org/fhir/Organization/Example-PayerOrganization1> ;
         fhir:Reference.reference [ fhir:value "Organization/Example-PayerOrganization1" ] ;
         fhir:Reference.display [ fhir:value "Acme Insurance Co" ]
      ] ;
      fhir:Coverage.class [
         fhir:index 0 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
             fhir:Coding.code [ fhir:value "group" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "993355" ] ;
         fhir:Coverage.class.name [ fhir:value "Stars Inc" ]
      ], [
         fhir:index 1 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
             fhir:Coding.code [ fhir:value "plan" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "11461128" ] ;
         fhir:Coverage.class.name [ fhir:value "Acme Gold Plus" ]
      ], [
         fhir:index 2 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS" ] ;
             fhir:Coding.code [ fhir:value "division" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "11" ]
      ], [
         fhir:index 3 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS" ] ;
             fhir:Coding.code [ fhir:value "network" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "561490" ] ;
         fhir:Coverage.class.name [ fhir:value "Acme Gold Plus South" ]
      ], [
         fhir:index 4 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
             fhir:Coding.code [ fhir:value "rxbin" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "100045" ]
      ], [
         fhir:index 5 ;
         fhir:Coverage.class.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ;
             fhir:Coding.code [ fhir:value "rxpcn" ]
           ]
         ] ;
         fhir:Coverage.class.value [ fhir:value "1234000" ]
      ] ;
      fhir:Coverage.costToBeneficiary [
         fhir:index 0 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamOutDed" ] ;
             fhir:Coding.display [ fhir:value "Family Out of Network Deductible" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 1 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamInDed" ] ;
             fhir:Coding.display [ fhir:value "Family In Network Deductible" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 2 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamRxOutDed" ] ;
             fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Deductible" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "2000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 3 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamRxInDed" ] ;
             fhir:Coding.display [ fhir:value "Family Pharmacy In Network Deductible" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "1500"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 4 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamOutMax" ] ;
             fhir:Coding.display [ fhir:value "Family Out of Network Out of Pocket Maximum" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "12000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 5 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamInMax" ] ;
             fhir:Coding.display [ fhir:value "Family In Network Out of Pocket Maximum" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 6 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamRxOutMax" ] ;
             fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Out of Pocket Maximum" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "3000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ], [
         fhir:index 7 ;
         fhir:Coverage.costToBeneficiary.type [
           fhir:CodeableConcept.coding [
             fhir:index 0 ;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ;
             fhir:Coding.code [ fhir:value "FamRxInMax" ] ;
             fhir:Coding.display [ fhir:value "Family Pharmacy In Network Out of Pocket Maximum" ]
           ]
         ] ;
         fhir:Coverage.costToBeneficiary.valueMoney [
           fhir:Money.value [ fhir:value "2000"^^xsd:decimal ] ;
           fhir:Money.currency [ fhir:value "USD" ]
         ]
      ] .

    <http://hl7.org/fhir/InsurancePlan/SBCExampleHMO> a fhir:InsurancePlan .

    <http://hl7.org/fhir/Patient/Example-Patient1> a fhir:Patient .

    <http://hl7.org/fhir/Patient/Example-Patient2> a fhir:Patient .

    <http://hl7.org/fhir/Organization/Example-PayerOrganization1> a fhir:Organization .

    # - ontology header ------------------------------------------------------------

    <http://hl7.org/fhir/Coverage/Example-Coverage-FSH.ttl> a owl:Ontology ;
      owl:imports fhir:fhir.ttl ;
      owl:versionIRI <http://build.fhir.org/Coverage/Example-Coverage-FSH.ttl> .