FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Eligibilityresponse-example-benefits.ttl

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Practitioner

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General Person Primary Coverage with Benefit Details

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/EligibilityResponse/E2501> a fhir:EligibilityResponse;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "E2501"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
  ];
  fhir:EligibilityResponse.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/eligibilityresponse" ];
     fhir:Identifier.value [ fhir:value "881234" ]
  ];
  fhir:EligibilityResponse.status [ fhir:value "active"];
  fhir:EligibilityResponse.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:EligibilityResponse.request [
     fhir:link <http://www.BenefitsInc.com/fhir/eligibility/225476332402>;
     fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/eligibility/225476332402" ]
  ];
  fhir:EligibilityResponse.outcome [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://hl7.org/fhir/remittance-outcome" ];
       fhir:Coding.code [ fhir:value "complete" ]
     ]
  ];
  fhir:EligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
  fhir:EligibilityResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:EligibilityResponse.inforce [ fhir:value "true"^^xsd:boolean];
  fhir:EligibilityResponse.insurance [
     fhir:index 0;
     fhir:EligibilityResponse.insurance.benefitBalance [
       fhir:index 0;
       fhir:EligibilityResponse.insurance.benefitBalance.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
           fhir:Coding.code [ fhir:value "medical" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
           fhir:Coding.code [ fhir:value "30" ];
           fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.financial [
         fhir:index 0;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "500000"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ], [
         fhir:index 1;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-maximum" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "100"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ], [
         fhir:index 2;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-percent" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
       ]
     ], [
       fhir:index 1;
       fhir:EligibilityResponse.insurance.benefitBalance.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
           fhir:Coding.code [ fhir:value "medical" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
           fhir:Coding.code [ fhir:value "69" ];
           fhir:Coding.display [ fhir:value "Maternity" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.financial [
         fhir:index 0;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "15000"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:EligibilityResponse.insurance.benefitBalance.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
           fhir:Coding.code [ fhir:value "oral" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
           fhir:Coding.code [ fhir:value "F3" ];
           fhir:Coding.display [ fhir:value "Dental Coverage" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.financial [
         fhir:index 0;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "2000"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:EligibilityResponse.insurance.benefitBalance.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
           fhir:Coding.code [ fhir:value "vision" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
           fhir:Coding.code [ fhir:value "F6" ];
           fhir:Coding.display [ fhir:value "Vision Coverage" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.financial [
         fhir:index 0;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "400"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:EligibilityResponse.insurance.benefitBalance.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-category" ];
           fhir:Coding.code [ fhir:value "vision" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.subCategory [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-subcategory" ];
           fhir:Coding.code [ fhir:value "49" ];
           fhir:Coding.display [ fhir:value "Hospital Room and Board" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/benefit-term" ];
           fhir:Coding.code [ fhir:value "day" ]
         ]
       ];
       fhir:EligibilityResponse.insurance.benefitBalance.financial [
         fhir:index 0;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "room" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedString [ fhir:value "shared" ]
       ], [
         fhir:index 1;
         fhir:EligibilityResponse.insurance.benefitBalance.financial.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:EligibilityResponse.insurance.benefitBalance.financial.allowedMoney [
           fhir:Quantity.value [ fhir:value "600"^^xsd:decimal ];
           fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
           fhir:Quantity.code [ fhir:value "SAR" ]
         ]
       ]
     ]
  ] .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/EligibilityResponse/E2501.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://hl7.org/fhir/STU3/EligibilityResponse/E2501.ttl> .

# -------------------------------------------------------------------------------------

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.