This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions 
General Person Primary Coverage with Benefit Details
{
"resourceType" : "CoverageEligibilityResponse",
"id" : "E2501",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
},
"identifier" : [{
"system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value" : "881234"
}],
"status" : "active",
"purpose" : ["validation",
"benefits"],
"patient" : {
"reference" : "Patient/pat1"
},
"servicedDate" : "2014-09-17",
"created" : "2014-08-16",
"request" : {
"reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"
},
"outcome" : "complete",
"disposition" : "Policy is currently in-force.",
"insurer" : {
"reference" : "Organization/2"
},
"insurance" : [{
"coverage" : {
"reference" : "Coverage/9876B1"
},
"inforce" : true,
"item" : [{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "30",
"display" : "Health Benefit Plan Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 500000,
"currency" : "SAR"
}
},
{
"type" : {
"coding" : [{
"code" : "copay-maximum"
}]
},
"allowedMoney" : {
"value" : 100,
"currency" : "SAR"
}
},
{
"type" : {
"coding" : [{
"code" : "copay-percent"
}]
},
"allowedUnsignedInt" : 20
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "69",
"display" : "Maternity"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 15000,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F3",
"display" : "Dental Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 2000,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F6",
"display" : "Vision Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 400,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "49",
"display" : "Hospital Room and Board"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "day"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "room"
}]
},
"allowedString" : "shared"
},
{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 600,
"currency" : "SAR"
}
}]
}]
}]
}
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.
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