CARIN Digital Insurance Card
1.1.0 - STU 1.1
CARIN Digital Insurance Card
1.1.0 - STU 1.1
This page is part of the CARIN Digital Insurance Card (v1.1.0: STU1) based on FHIR (HL7® FHIR® Standard) 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
@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 ------------------------------------------------------------------- a fhir:Coverage ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "Example-Coverage-FSH"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; fhir:lastUpdated [ fhir:v "2021-04-06T10:49:02.473+00:00"^^xsd:dateTime ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"Example-Coverage-FSH\"> </a><a name=\"hcExample-Coverage-FSH\"> </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 "Example-Coverage-FSH" Version "1" 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><blockquote><p><b>url</b></p><code>memberId</code></blockquote><p><b>value</b>: 102345672-01</p><blockquote><p><b>url</b></p><code>name</code></blockquote><p><b>value</b>: John Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><blockquote><p><b>url</b></p><code>memberId</code></blockquote><p><b>value</b>: 102345672-02</p><blockquote><p><b>url</b></p><code>name</code></blockquote><p><b>value</b>: jane Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><blockquote><p><b>url</b></p><code>memberId</code></blockquote><p><b>value</b>: 102345672-03</p><blockquote><p><b>url</b></p><code>name</code></blockquote><p><b>value</b>: Jimmy Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><blockquote><p><b>url</b></p><code>memberId</code></blockquote><p><b>value</b>: 102345672-04</p><blockquote><p><b>url</b></p><code>name</code></blockquote><p><b>value</b>: Ginny Doe </p></blockquote><p><b>Additional Insurance Card Information</b>: 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><p><b>Card Issue Date</b>: 2020-12-15</p><blockquote><p><b>Color Palette</b></p><blockquote><p><b>url</b></p><a href=\"StructureDefinition-C4DIC-BackgroundColor-extension.html\">Background Color</a></blockquote><p><b>value</b>: #00bfff <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-IECColourManagement.html\">IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB</a>##00bfff)</span></p><blockquote><p><b>url</b></p><a href=\"StructureDefinition-C4DIC-ForegroundColor-extension.html\">Foreground Color</a></blockquote><p><b>value</b>: #000000 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-IECColourManagement.html\">IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB</a>##000000)</span></p><blockquote><p><b>url</b></p><a href=\"StructureDefinition-C4DIC-HighlightColor-extension.html\">Highlight Color</a></blockquote><p><b>value</b>: #ceebf5 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-IECColourManagement.html\">IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB</a>##ceebf5)</span></p></blockquote><blockquote><p><b>Logo</b></p><blockquote><p><b>url</b></p><code>description</code></blockquote><p><b>value</b>: Company logo</p><blockquote><p><b>url</b></p><code>image</code></blockquote><p><b>value</b>: </p><blockquote><p><b>url</b></p><code>label</code></blockquote><p><b>value</b>: ACME Inc.</p></blockquote><blockquote><p><b>QR Code</b></p><blockquote><p><b>url</b></p><code>description</code></blockquote><p><b>value</b>: Usage text for this QR code for the end user</p><blockquote><p><b>url</b></p><code>image</code></blockquote><p><b>value</b>: </p><blockquote><p><b>url</b></p><code>label</code></blockquote><p><b>value</b>: Some label for this QR code</p></blockquote><blockquote><p><b>Barcode</b></p><blockquote><p><b>url</b></p><code>description</code></blockquote><p><b>value</b>: Usage text for this Barcode for the end user</p><blockquote><p><b>url</b></p><code>image</code></blockquote><p><b>value</b>: </p><blockquote><p><b>url</b></p><code>label</code></blockquote><p><b>value</b>: Some label for this Barcode</p></blockquote><blockquote><p><b>Supporting image</b></p><blockquote><p><b>url</b></p><code>description</code></blockquote><p><b>value</b>: Some text for the end user about the usage/meaning of this image</p><blockquote><p><b>url</b></p><code>image</code></blockquote><p><b>value</b>: </p><blockquote><p><b>url</b></p><code>label</code></blockquote><p><b>value</b>: Some label text</p></blockquote><p><b>identifier</b>: Member Number/102345672-02</p><p><b>status</b>: active</p><p><b>type</b>: health insurance plan policy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#HIP)</span></p><p><b>subscriber</b>: <a href=\"Patient-Example-Patient1.html\">Patient/Example-Patient1: John Doe</a> " DOE"</p><p><b>subscriberId</b>: 102345672-01</p><p><b>beneficiary</b>: <a href=\"Patient-Example-Patient2.html\">Patient/Example-Patient2: Jane Doe</a> " DOE"</p><p><b>dependent</b>: 02</p><p><b>relationship</b>: Spouse <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#spouse)</span></p><p><b>period</b>: 2021-01-01 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-Example-PayerOrganization1.html\">Organization/Example-PayerOrganization1: Acme Insurance Co</a> "Acme Insurance Co"</p><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#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>: Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#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>: Division <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCoverageClassCS.html\">C4DIC Extended Coverage Class</a>#division)</span></p><p><b>value</b>: 11</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Network <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCoverageClassCS.html\">C4DIC Extended Coverage Class</a>#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>: RX BIN <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxbin)</span></p><p><b>value</b>: 100045</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: RX PCN <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxpcn)</span></p><p><b>value</b>: 1234000</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: Family Out of Network Deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamOutDed)</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>: Family In Network Deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamInDed)</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>: Family Pharmacy Out of Network Deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamRxOutDed)</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>: Family Pharmacy In Network Deductible <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamRxInDed)</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>: Family Out of Network Out of Pocket Maximum <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamOutMax)</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>: Family In Network Out of Pocket Maximum <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamInMax)</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>: Family Pharmacy Out of Network Out of Pocket Maximum <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamRxOutMax)</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>: Family Pharmacy In Network Out of Pocket Maximum <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-C4DICExtendedCopayTypeCS.html\">C4DIC Extended Copay Type</a>#FamRxInMax)</span></p><p><b>value</b>: <span title=\"US Dollar\">$2,000.00</span> (USD)</p></blockquote></div>" ] ; # fhir:extension ( [ ( fhir:extension [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ] ; fhir:value [ fhir:v "102345672-01" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; ( fhir:given [ fhir:v "John" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ] ; fhir:value [ fhir:v "102345672-02" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; ( fhir:given [ fhir:v "jane" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ] ; fhir:value [ fhir:v "102345672-03" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; ( fhir:given [ fhir:v "Jimmy" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ] ; fhir:value [ fhir:v "102345672-04" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; ( fhir:given [ fhir:v "Ginny" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension"^^xsd:anyURI ] ; fhir:value [ a fhir:Annotation ; fhir:text [ fhir:v "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:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension"^^xsd:anyURI ] ; fhir:value [ fhir:v "2020-12-15"^^xsd:date ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ] ; fhir:code [ fhir:v "#00bfff" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ] ; fhir:code [ fhir:v "#000000" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ] ; fhir:code [ fhir:v "#ceebf5" ] ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "description"^^xsd:anyURI ] ; fhir:value [ fhir:v "Company logo" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "ACME Inc." ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "description"^^xsd:anyURI ] ; fhir:value [ fhir:v "Usage text for this QR code for the end user" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "Some label for this QR code" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "description"^^xsd:anyURI ] ; fhir:value [ fhir:v "Usage text for this Barcode for the end user" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "Some label for this Barcode" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "description"^^xsd:anyURI ] ; fhir:value [ fhir:v "Some text for the end user about the usage/meaning of this image" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "Some label text" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"^^xsd:anyURI ] ] ) ; # 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 "https://www.acmeinsurance.com/glossary/memberid"^^xsd:anyURI ] ; fhir:value [ fhir:v "102345672-02" ] ; fhir:assigner [ fhir:display [ fhir:v "Acme Insurance Co" ] ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "HIP" ] ; fhir:display [ fhir:v "health insurance plan policy" ] ] ) ; fhir:text [ fhir:v "health insurance plan policy" ] ] ; # fhir:subscriber [ fhir:reference [ fhir:v "Patient/Example-Patient1" ] ; fhir:display [ fhir:v "John Doe" ] ] ; # fhir:subscriberId [ fhir:v "102345672-01"] ; # fhir:beneficiary [ fhir:reference [ fhir:v "Patient/Example-Patient2" ] ; fhir:display [ fhir:v "Jane Doe" ] ] ; # fhir:dependent [ fhir:v "02"] ; # fhir:relationship [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ; fhir:code [ fhir:v "spouse" ] ; fhir:display [ fhir:v "Spouse" ] ] ) ; fhir:text [ fhir:v "Spouse" ] ] ; # fhir:period [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ] ; # fhir:payor ( [ fhir:reference [ fhir:v "Organization/Example-PayerOrganization1" ] ; fhir:display [ fhir:v "Acme Insurance Co" ] ] ) ; # 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:value [ fhir:v "993355" ] ; fhir:name [ fhir:v "Stars Inc" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "plan" ] ] ) ] ; fhir:value [ fhir:v "11461128" ] ; fhir:name [ fhir:v "Acme Gold Plus" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "division" ] ] ) ] ; fhir:value [ fhir:v "11" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "network" ] ] ) ] ; fhir:value [ fhir:v "561490" ] ; fhir:name [ fhir:v "Acme Gold Plus South" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxbin" ] ] ) ] ; fhir:value [ fhir:v "100045" ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ; fhir:code [ fhir:v "rxpcn" ] ] ) ] ; fhir:value [ fhir:v "1234000" ] ] ) ; # fhir:costToBeneficiary ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamOutDed" ] ; fhir:display [ fhir:v "Family Out of Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamInDed" ] ; fhir:display [ fhir:v "Family In Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "8000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamRxOutDed" ] ; fhir:display [ fhir:v "Family Pharmacy Out of Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamRxInDed" ] ; fhir:display [ fhir:v "Family Pharmacy In Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "1500"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamOutMax" ] ; fhir:display [ fhir:v "Family Out of Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "12000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamInMax" ] ; fhir:display [ fhir:v "Family In Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamRxOutMax" ] ; fhir:display [ fhir:v "Family Pharmacy Out of Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "3000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ] ; fhir:code [ fhir:v "FamRxInMax" ] ; fhir:display [ fhir:v "Family Pharmacy In Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) . #
IG © 2022+ HL7 International / Payer/Provider Information Exchange Work Group. Package hl7.fhir.us.insurance-card#1.1.0 based on FHIR 4.0.1. Generated 2024-04-16
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