R4 Draft for Comment
FinancialThis page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Practitioner |
General Person Primary Coverage with Benefit Details and new insurance
{
"resourceType": "EligibilityResponse",
"id": "E2502",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
},
"contained": [
{
"resourceType": "Patient",
"id": "patient-1",
"name": [
{
"use": "official",
"family": "Donald",
"given": [
"Duck"
]
}
],
"gender": "male",
"birthDate": "1986-05-17",
"address": [
{
"use": "home",
"line": [
"1234 Main Street"
],
"city": "Vancouver",
"postalCode": "V2H1Y3",
"country": "CAD"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage-1",
"identifier": [
{
"system": "http://benefitsinc.com/certificate",
"value": "12345"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/v3/ActCode",
"code": "EHCPOL"
}
]
},
"subscriber": {
"reference": "#patient-1"
},
"beneficiary": {
"reference": "#patient-1"
},
"dependent": "1",
"relationship": {
"coding": [
{
"code": "self"
}
]
},
"payor": [
{
"identifier": {
"system": "http://www.bindb.com/bin",
"value": "123456"
}
}
],
"grouping": {
"plan": "CBI35",
"planDisplay": "Corporate Baker's Inc. Plan#35",
"subPlan": "123",
"subPlanDisplay": "Trainee Part-time Benefits"
},
"sequence": "1"
}
],
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/eligibilityresponse",
"value": "8812342"
}
],
"status": "active",
"created": "2014-09-16",
"requestProvider": {
"identifier": {
"system": "http://national.org/provider",
"value": "PR9876"
}
},
"requestOrganization": {
"identifier": {
"system": "http://national.org/clinic",
"value": "OR1234"
}
},
"request": {
"reference": "http://www.BenefitsInc.com/fhir/eligibility/225476332405"
},
"outcome": "complete",
"disposition": "Policy is currently in-force.",
"insurer": {
"reference": "Organization/2"
},
"inforce": true,
"insurance": [
{
"coverage": {
"reference": "#coverage-1"
},
"contract": {
"reference": "http://www.BenefitsInc.com/fhir/contract/NBU22547"
},
"benefitBalance": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-category",
"code": "medical"
}
]
},
"subCategory": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "30",
"display": "Health Benefit Plan Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-term",
"code": "annual"
}
]
},
"financial": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 500000,
"system": "urn:iso:std:iso:4217",
"code": "USD"
},
"usedMoney": {
"value": 3748.00,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"code": "copay-maximum"
}
]
},
"allowedMoney": {
"value": 100,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"type": {
"coding": [
{
"code": "copay-percent"
}
]
},
"allowedUnsignedInt": 20
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-category",
"code": "medical"
}
]
},
"subCategory": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "69",
"display": "Maternity"
}
]
},
"network": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-term",
"code": "annual"
}
]
},
"financial": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 15000,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-category",
"code": "oral"
}
]
},
"subCategory": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "F3",
"display": "Dental Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-term",
"code": "annual"
}
]
},
"financial": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 2000,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}
]
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-category",
"code": "vision"
}
]
},
"subCategory": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "F6",
"display": "Vision Coverage"
}
]
},
"excluded": true,
"name": "Vision",
"description": "Vision products and services such as exams, glasses and contatc lenses."
}
]
}
],
"form": {
"coding": [
{
"system": "http://national.org/form",
"code": "ELRSP/2017/01"
}
]
}
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
®© HL7.org 2011+. FHIR Release 4 Draft for Comment (Jan-2018 v3.2.0-12885) generated on Wed, Dec 20, 2017 15:57+1100. QA Page
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