CARIN Digital Insurance Card
1.0.0 - STU 1
US
CARIN Digital Insurance Card
1.0.0 - STU 1
US
This page is part of the CARIN Digital Insurance Card (v1.0.0: STU 1) based on FHIR 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: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><b>Generated Narrative</b></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 \"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><p><b>value</b>: 102345672-01</p><p><b>value</b>: John Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><p><b>value</b>: 102345672-02</p><p><b>value</b>: jane Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><p><b>value</b>: 102345672-03</p><p><b>value</b>: Jimmy Doe </p></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><p><b>value</b>: 102345672-04</p><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><p><b>Background Color</b>: #00bfff <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/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><p><b>Highlight Color</b>: #ceebf5 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/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><p><b>Logo</b></p><p><b>value</b>: ACME Inc.</p><p><b>value</b>: Company logo</p><p><b>value</b>: </p></blockquote><blockquote><p><b>QR Code</b></p><p><b>value</b>: Some label for this QR code</p><p><b>value</b>: Usage text for this QR code for the end user</p><p><b>value</b>: </p></blockquote><blockquote><p><b>Barcode</b></p><p><b>value</b>: Some label for this Barcode</p><p><b>value</b>: Usage text for this Barcode for the end user</p><p><b>value</b>: </p></blockquote><blockquote><p><b>Supporting image</b></p><p><b>value</b>: Some label text</p><p><b>value</b>: Some text for the end user about the usage/meaning of this image</p><p><b>value</b>: </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/3.1.0/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/3.1.0/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/3.1.0/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/3.1.0/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/3.1.0/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/3.1.0/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><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: GP Office Visit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-copay-type.html\">Coverage Copay Type Codes</a>#gpvisit)</span></p><p><b>value</b>: </p></blockquote><p><b style=\"color: maroon\">Exception generating Narrative: null</b></p></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-CardIssueDate-extension" ];
fhir:Extension.valueDate [ fhir:value "2020-12-15"^^xsd:date ]
], [
fhir:index 6;
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 7;
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:index 8;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "label" ];
fhir:Extension.valueString [ fhir:value "ACME Inc." ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Company logo" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
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 "label" ];
fhir:Extension.valueString [ fhir:value "Some label for this QR code" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Usage text for this QR code for the end user" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
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 "label" ];
fhir:Extension.valueString [ fhir:value "Some label for this Barcode" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Usage text for this Barcode for the end user" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "iVBORw0KGgoAAAANSUhEUgAAABAAAAAkCAQAAAAqEXJRAAAABGdBTUEAALGPC/xhBQAAACBjSFJNAAB6JgAAgIQAAPoAAACA6AAAdTAAAOpgAAA6mAAAF3CculE8AAAAAmJLR0QA/4ePzL8AAAAHdElNRQflCBoOCChye9NTAAAAsklEQVQ4y+WSsQrCMBCGv9ZCUdwUBEcfR+c+kVPewHdxdxEcBQW1FBTpkFoQ6iJxiSHaRCdB9L/l5+6/kP/uAHpMOKCeYoegDdBlUyveY06zwZghPvQpYe3tVyhmARdi/DhGVvnEVLMRLc1irOcWRpqanAx5g98QRI6WhI6dsAcVkrB82IW0BTmr2rJkgHr5heIzNgsqv+CMYEDutlkh9ARSt81/PpjvONqt4XvDMq6alTdjhHqxFxxRQAAAACV0RVh0ZGF0ZTpjcmVhdGUAMjAyMS0wOC0yNlQxNDowODo0MCswMDowMF+TI3oAAAAldEVYdGRhdGU6bW9kaWZ5ADIwMjEtMDgtMjZUMTQ6MDg6NDArMDA6MDAuzpvGAAAAAElFTkSuQmCC"^^xsd:base64Binary ] ] ];
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 "label" ];
fhir:Extension.valueString [ fhir:value "Some label text" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "description" ];
fhir:Extension.valueString [ fhir:value "Some text for the end user about the usage/meaning of this image" ] ], [
fhir:index 2;
fhir:Extension.url [ fhir:value "image" ];
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ];
fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ];
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: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: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: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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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://hl7.org/fhir/us/insurance-card/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" ] ]
], [
fhir:index 8;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "gpvisit" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ] ]
], [
fhir:index 9;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "spvisit" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ] ]
], [
fhir:index 10;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ];
fhir:Coding.code [ fhir:value "emergency" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ];
fhir:Extension.valueString [ fhir:value "N/A" ] ] ]
], [
fhir:index 11;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS" ];
fhir:Coding.code [ fhir:value "rx" ] ] ];
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ];
fhir:Extension.valueString [ fhir:value "DED THEN $10/$40/$70/25%" ] ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2022+ HL7 Payer/Provider Information Exchange Working Group (PIE WG). Package hl7.fhir.us.insurance-card#1.0.0 based on FHIR 4.0.1. Generated 2022-07-13
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