This page is part of the US Core (v7.0.0: STU7) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions. Page versions: STU6.1 STU6

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: Coverage Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="coverage-example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Coverage</b><a name="coverage-example"> </a><a name="hccoverage-example"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Coverage &quot;coverage-example&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-us-core-coverage.html">US Core Coverage Profile (version 7.0.0)</a></p></div><p><b>identifier</b>: Member Number/88800933501</p><p><b>status</b>: active</p><p><b>type</b>: PPO <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://nahdo.org/sopt">Source of Payment Typology</a>#3712; <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html">ActCode</a>#PPO &quot;preferred provider organization policy&quot;)</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href="Patient-example.html">Patient/example</a> &quot; SHAW&quot;</p><p><b>relationship</b>: Self <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-subscriber-relationship.html">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2020-01-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href="Organization-acme-payer.html">Organization/acme-payer: Acme Health Plan</a> &quot;Acme Health Plan&quot;</p><blockquote><p><b>class</b></p><p><b>type</b>: An employee group <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#group &quot;Group&quot;)</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>: A specific suite of benefits. <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-coverage-class.html">Coverage Class Codes</a>#plan &quot;Plan&quot;)</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
    </type>
    <system value="http://example.org/fhir/memberidentifier"/>
    <value value="88800933501"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="https://nahdo.org/sopt"/>
      <code value="3712"/>
      <display value="PPO"/>
    </coding>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="PPO"/>
      <display value="preferred provider organization policy"/>
    </coding>
    <text value="PPO"/>
  </type>
  <subscriberId value="888009335"/>
  <beneficiary>🔗 
    <reference value="Patient/example"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
    <text value="Self"/>
  </relationship>
  <period>
    <start value="2020-01-01"/>
  </period>
  <payor>🔗 
    <reference value="Organization/acme-payer"/>
    <display value="Acme Health Plan"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
        <display value="Group"/>
      </coding>
      <text value="An employee group"/>
    </type>
    <value value="xyz"/>
    <name value="XYZ employee Group Plan"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
        <display value="Plan"/>
      </coding>
      <text value="A specific suite of benefits."/>
    </type>
    <value value="gold"/>
    <name value="Acme Gold Plan"/>
  </class>
</Coverage>