US Quality Core Implementation Guide
1.0.0-ballot - STU 1 - ballot United States of America flag

This page is part of the US Quality Core Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

Example Coverage: Coverage example

Page standards status: Informative

identifier: Member ID/MB123456789

status: Active

type: Preferred Provider Organization (PPO)

policyHolder: Example Patient Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

subscriber: Example Patient Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

subscriberId: SUB987654321

beneficiary: Example Patient Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

dependent: 0

relationship: Self

period: 2026-01-01 --> 2026-12-31

payor: Organization Example Organization

class

type: Group

value: GRP-99482

name: Example Employer Health Plan

class

type: Plan

value: PLN-GOLD-2026

name: Example PPO Option