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

<Coverage xmlns="http://hl7.org/fhir">
  <id value="qicore-coverage-example"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <system value="http://benefitsinc.com/certificate"/>
    <value value="12345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/v3/ActCode"/>
      <code value="EHCPOL"/>
      <display value="extended healthcare"/>
    </coding>
  </type>
  <policyHolder>
    <reference value="Patient/qicore-patient-example"/>
  </policyHolder>
  <subscriber>
    <reference value="Patient/qicore-patient-example"/>
  </subscriber>
  <beneficiary>
    <reference value="Patient/qicore-patient-example"/>
  </beneficiary>
  <relationship>
    <coding>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2011-05-23"/>
    <end value="2012-05-23"/>
  </period>
  <payor>
    <reference value="Organization/qicore-organization-example"/>
  </payor>
  <grouping>
    <group value="CBI35"/>
    <groupDisplay value="Corporate Baker&#39;s Inc. Local #35"/>
    <subGroup value="123"/>
    <subGroupDisplay value="Trainee Part-time Benefits"/>
    <plan value="B37FC"/>
    <planDisplay value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>
    <subPlan value="P7"/>
    <subPlanDisplay value="Includes afterlife benefits"/>
    <class value="SILVER"/>
    <classDisplay value="Silver: Family Plan spouse only"/>
    <subClass value="Tier2"/>
    <subClassDisplay value="Low deductable, max $20 copay"/>
  </grouping>
  <dependent value="0"/>
  <sequence value="9"/>
</Coverage>