This page is part of the US Core (v8.0.0-ballot: STU8 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

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: Coverage Example - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "coverage-example",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|8.0.0-ballot"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage coverage-example</b></p><a name=\"coverage-example\"> </a><a name=\"hccoverage-example\"> </a><a name=\"coverage-example-en-US\"> </a><p><b>identifier</b>: Member Number/88800933501</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nahdo.org/sopt 3712}, {http://terminology.hl7.org/CodeSystem/v3-ActCode PPO}\">PPO</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Amy V. Baxter  Female, DoB: 1987-02-20 ( Medical Record Number:\u00a01032702\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Acme Health Plan</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">An employee group</span></p><p><b>value</b>: xyz</p><p><b>name</b>: XYZ employee Group Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">A specific suite of benefits.</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ]
      },
      "system" : "http://example.org/fhir/memberidentifier",
      "value" : "88800933501"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "https://nahdo.org/sopt",
        "code" : "3712",
        "display" : "PPO"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "PPO",
        "display" : "preferred provider organization policy"
      }
    ],
    "text" : "PPO"
  },
  "subscriberId" : "888009335",
  "beneficiary" : {
    🔗 "reference" : "Patient/example"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ],
    "text" : "Self"
  },
  "period" : {
    "start" : "2020-01-01"
  },
  "payor" : [
    {
      🔗 "reference" : "Organization/acme-payer",
      "display" : "Acme Health Plan"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group",
            "display" : "Group"
          }
        ],
        "text" : "An employee group"
      },
      "value" : "xyz",
      "name" : "XYZ employee Group Plan"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ],
        "text" : "A specific suite of benefits."
      },
      "value" : "gold",
      "name" : "Acme Gold Plan"
    }
  ]
}