This page is part of the Quality Improvement Core Framework (v3.1.0: STU 3) based on FHIR (HL7® FHIR® Standard) R3. The current version which supersedes this version is 7.0.1. For a full list of available versions, see the Directory of published versions

Coverage example

Formats: Narrative, XML, JSON, Turtle

Raw json

{
  "resourceType" : "Coverage",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example</p><p><b>meta</b>: </p><p><b>identifier</b>: 12345</p><p><b>status</b>: active</p><p><b>type</b>: extended healthcare <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/v3/ActCode code 'EHCPOL' = 'extended healthcare', given as 'extended healthcare'})</span></p><p><b>policyHolder</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>subscriber</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>beneficiary</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974; </a></p><p><b>relationship</b>: self <span style="background: LightGoldenRodYellow">(Details : {[not stated] code 'self' = 'self)</span></p><p><b>period</b>: 23/05/2011 12:00:00 AM --&gt; 23/05/2012 12:00:00 AM</p><p><b>payor</b>: <a href="Organization-example.html">Generated Summary: id: example; ??; active; <span title="Codes: {http://hl7.org/fhir/organization-type team}">Organizational team</span>; name: Health Level Seven International; ph: (+1) 734-677-7777, fax: (+1) 734-677-6622, hq@HL7.org</a></p><h3>Groupings</h3><table class="grid"><tr><td>-</td><td><b>Group</b></td><td><b>GroupDisplay</b></td><td><b>SubGroup</b></td><td><b>SubGroupDisplay</b></td><td><b>Plan</b></td><td><b>PlanDisplay</b></td><td><b>SubPlan</b></td><td><b>SubPlanDisplay</b></td><td><b>Class</b></td><td><b>ClassDisplay</b></td><td><b>SubClass</b></td><td><b>SubClassDisplay</b></td></tr><tr><td>*</td><td>CBI35</td><td>Corporate Baker's Inc. Local #35</td><td>123</td><td>Trainee Part-time Benefits</td><td>B37FC</td><td>Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</td><td>P7</td><td>Includes afterlife benefits</td><td>SILVER</td><td>Silver: Family Plan spouse only</td><td>Tier2</td><td>Low deductable, max $20 copay</td></tr></table><p><b>dependent</b>: 0</p><p><b>sequence</b>: 9</p></div>"
  },
  "identifier" : [
    {
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/v3/ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "policyHolder" : {
    "reference" : "Patient/example"
  },
  "subscriber" : {
    "reference" : "Patient/example"
  },
  "beneficiary" : {
    "reference" : "Patient/example"
  },
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      "reference" : "Organization/example"
    }
  ],
  "grouping" : {
    "group" : "CBI35",
    "groupDisplay" : "Corporate Baker's Inc. Local #35",
    "subGroup" : "123",
    "subGroupDisplay" : "Trainee Part-time Benefits",
    "plan" : "B37FC",
    "planDisplay" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC",
    "subPlan" : "P7",
    "subPlanDisplay" : "Includes afterlife benefits",
    "class" : "SILVER",
    "classDisplay" : "Silver: Family Plan spouse only",
    "subClass" : "Tier2",
    "subClassDisplay" : "Low deductable, max $20 copay"
  },
  "dependent" : "0",
  "sequence" : "9"
}