Coverage-example.xml

General Person Primary Coverage Example (id = "9876B1")

<Coverage xmlns="http://hl7.org/fhir">
  <id value="9876B1"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</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="http://benefitsinc.com/FHIR/Organization/CBI35"/> 
  </policyHolder> 

  <subscriber> 
    <reference value="Patient/4"/> 
  </subscriber> 

  <beneficiary> 
    <reference value="Patient/4"/> 
  </beneficiary> 
  <dependent value="0"/>  
  <relationship> 
    <coding> 
      <code value="self"/> 
    </coding> 
  </relationship> 

  <period>  
    <start value="2011-05-23"/> 
    <end value="2012-05-23"/> 
  </period> 

  <payor> 
    <reference value="Organization/2"/> 
  </payor> 

  <grouping> 
    <group value="CBI35"/> 
    <groupDisplay value="Corporate Baker'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> 

  <sequence value="9"/> 

</Coverage>