This page is part of the Quality Improvement Core Framework (v2.1.0: STU 3 Ballot 1) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Coverage qicore-coverage-example

{
  "resourceType" : "Coverage",
  "id" : "qicore-coverage-example",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns="http://www.w3.org/1999/xhtml">
      <p>A human-readable rendering of the coverage</p>
      <p>
        <strong>identifier</strong>: 12345
      </p>
      <p>
        <strong>status</strong>: active
      </p>
      <p>
        <strong>code</strong>: ActCode
        <span>(Details: { FHIR code 'EHCPOL' = 'extended healthcare' })</span>
      </p>
      <p>
        <strong>policyHolder</strong>: 
        <a href="Organization-qicore-organization-example.html">Organization/example</a>
      </p>
      <p>
        <strong>subscriber</strong>: 
        <a href="Patient-qicore-patient-example.html">Patient/example</a>
      </p>
      <p>
        <strong>beneficiary</strong>: 
        <a href="Patient-qicore-patient-example.html">Patient/example</a>
      </p>
      <p>
        <strong>relationship</strong>: self
      </p>
      <blockquote>
        <p><strong>period</strong></p>
        <p>
          <strong>start</strong>: 05/23/2011
        </p>
        <p>
          <strong>start</strong>: 05/23/2012
        </p>
      </blockquote>
      <p>
        <strong>organization</strong>: 
        <a href="Organization-qicore-organization-example.html">Organization/example</a>
      </p>
      <blockquote>
        <p><strong>grouping</strong></p>
        <p>
          <strong>group</strong>: Corporate Baker's Inc. Local #35
        </p>
        <p>
          <strong>subGroup</strong>: Trainee Part-time Benefits
        </p>
        <p>
          <strong>plan</strong>: Full Coverage: Medical, Dental, Pharmacy, Vision, EHC
        </p>
        <p>
          <strong>subPlan</strong>: Includes afterlife benefits
        </p>
        <p>
          <strong>class</strong>: Silver: Family Plan spouse only
        </p>
        <p>
          <strong>subClass</strong>: Low deductable, max $20 copay
        </p>
      </blockquote>
      <p>
        <strong>dependent</strong>: 0
      </p>
      <p>
        <strong>sequence</strong>: 9
      </p>
    </div>"
  },
  "identifier" : [
    {
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/v3/ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "policyHolder" : {
    "reference" : "Patient/qicore-patient-example"
  },
  "subscriber" : {
    "reference" : "Patient/qicore-patient-example"
  },
  "beneficiary" : {
    "reference" : "Patient/qicore-patient-example"
  },
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      "reference" : "Organization/qicore-organization-example"
    }
  ],
  "grouping" : {
    "group" : "CBI35",
    "groupDisplay" : "Corporate Baker's Inc. Local #35",
    "subGroup" : "123",
    "subGroupDisplay" : "Trainee Part-time Benefits",
    "plan" : "B37FC",
    "planDisplay" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC",
    "subPlan" : "P7",
    "subPlanDisplay" : "Includes afterlife benefits",
    "class" : "SILVER",
    "classDisplay" : "Silver: Family Plan spouse only",
    "subClass" : "Tier2",
    "subClassDisplay" : "Low deductable, max $20 copay"
  },
  "dependent" : "0",
  "sequence" : "9"
}