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Coverage "SP1234" Version "1"

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A human-readable rendering of a Self Pay Agreement.

{
  "resourceType" : "Coverage",
  "id" : "SP1234",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:26.364Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a Self Pay Agreement.</div>"
  },
  "identifier" : [
    {
      "system" : "http://hospitalx.com/selfpayagreement",
      "value" : "SP12345678"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
        "code" : "pay",
        "display" : "PAY"
      }
    ]
  },
  "subscriber" : {
    "reference" : "Patient/5"
  },
  "beneficiary" : {
    "reference" : "Patient/5"
  },
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "end" : "2012-03-17"
  },
  "payor" : [
    {
      "reference" : "Patient/5"
    }
  ]
}

Coverage "9876B1" Version "1"

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A human-readable rendering of the coverage

{
  "resourceType" : "Coverage",
  "id" : "9876B1",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:26.301Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "identifier" : [
    {
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "policyHolder" : {
    "reference" : "http://benefitsinc.com/FHIR/Organization/CBI35"
  },
  "subscriber" : {
    "reference" : "Patient/4"
  },
  "beneficiary" : {
    "reference" : "Patient/4"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      "reference" : "Organization/2"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "CB135",
      "name" : "Corporate Baker's Inc. Local #35"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subgroup"
          }
        ]
      },
      "value" : "123",
      "name" : "Trainee Part-time Benefits"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ]
      },
      "value" : "B37FC",
      "name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subplan"
          }
        ]
      },
      "value" : "P7",
      "name" : "Includes afterlife benefits"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "class"
          }
        ]
      },
      "value" : "SILVER",
      "name" : "Silver: Family Plan spouse only"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subclass"
          }
        ]
      },
      "value" : "Tier2",
      "name" : "Low deductable, max $20 copay"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "sequence"
          }
        ]
      },
      "value" : "9"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxid"
          }
        ]
      },
      "value" : "MDF12345"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxbin"
          }
        ]
      },
      "value" : "987654"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxgroup"
          }
        ]
      },
      "value" : "M35PT"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxpcn"
          }
        ]
      },
      "value" : "234516"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "sequence"
          }
        ]
      },
      "value" : "9"
    }
  ]
}

Coverage "7547E" Version "1"

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Updated: by

A human-readable rendering of the European Health Insurance Card

{
  "resourceType" : "Coverage",
  "id" : "7547E",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:26.270Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the European Health Insurance Card</div>"
  },
  "identifier" : [
    {
      "system" : "http://ehic.com/insurer/123456789/member",
      "value" : "A123456780"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "subscriber" : {
    "reference" : "Patient/5"
  },
  "beneficiary" : {
    "reference" : "Patient/5"
  },
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "end" : "2012-03-17"
  },
  "payor" : [
    {
      "identifier" : {
        "system" : "http://ehic.com/insurer",
        "value" : "123456789"
      }
    }
  ]
}

Coverage "7546D" Version "1"

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This Resource , XML or JSON representation, or the full version history.. provenance for this resource
Updated: by

A human-readable rendering of the coverage

{
  "resourceType" : "Coverage",
  "id" : "7546D",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:26.239Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  },
  "identifier" : [
    {
      "system" : "http://xyz.com/codes/identifier",
      "value" : "AB98761"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "subscriber" : {
    "reference" : "Patient/5"
  },
  "subscriberId" : "AB9876",
  "beneficiary" : {
    "reference" : "Patient/5"
  },
  "dependent" : "1",
  "relationship" : {
    "coding" : [
      {
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-03-17",
    "end" : "2012-03-17"
  },
  "payor" : [
    {
      "reference" : "Organization/2"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "WESTAIR",
      "name" : "Western Airlines"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ]
      },
      "value" : "BG4352",
      "name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subplan"
          }
        ]
      },
      "value" : "D15C9",
      "name" : "Platinum"
    }
  ],
  "order" : 2,
  "network" : "5",
  "costToBeneficiary" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
            "code" : "gpvisit"
          }
        ]
      },
      "valueMoney" : {
        "value" : 20.00,
        "currency" : "USD"
      },
      "exception" : [
        {
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception",
                "code" : "retired"
              }
            ]
          },
          "period" : {
            "start" : "2018-01-01",
            "end" : "2018-12-31"
          }
        }
      ]
    }
  ],
  "contract" : [
    {
      "reference" : "Contract/INS-101"
    }
  ]
}