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| Responsible Owner: Financial Management Work Group | Standards Status : Informative | Compartments : Patient , Practitioner |
Raw JSON ( canonical form + also see JSON Format Specification )
General Person Primary Coverage with Benefit Details
{
"resourceType": "CoverageEligibilityResponse",
"id": "E2501",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
"resourceType" : "CoverageEligibilityResponse",
"id" : "E2501",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
},
"identifier": [
{
"system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value": "881234"
}
],
"status": "active",
"purpose": [
"validation",
"benefits"
],
"patient": {
"reference": "Patient/pat1"
"identifier" : [{
"system" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
"value" : "881234"
}],
"status" : "active",
"purpose" : ["validation",
"benefits"],
"patient" : {
"reference" : "Patient/pat1"
},
"servicedDate": "2014-09-17",
"created": "2014-08-16",
"request": {
"reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"
"servicedDate" : "2014-09-17",
"created" : "2014-08-16",
"request" : {
"reference" : "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"
},
"outcome": "complete",
"disposition": "Policy is currently in-force.",
"insurer": {
"reference": "Organization/2"
"outcome" : "complete",
"disposition" : "Policy is currently in-force.",
"insurer" : {
"reference" : "Organization/2"
},
"insurance": [
"insurance" : [{
"coverage" : {
"reference" : "Coverage/9876B1"
},
"inforce" : true,
"item" : [{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "30",
"display" : "Health Benefit Plan Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 500000,
"currency" : "SAR"
}
},
{
"type" : {
"coding" : [{
"code" : "copay-maximum"
}]
},
"allowedMoney" : {
"value" : 100,
"currency" : "SAR"
}
},
{
"type" : {
"coding" : [{
"code" : "copay-percent"
}]
},
"allowedUnsignedInt" : 20
}]
},
{
"coverage": {
"reference": "Coverage/9876B1"
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "69",
"display" : "Maternity"
}]
},
"inforce": true,
"item": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "30",
"display": "Health Benefit Plan Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 500000,
"currency": "SAR"
}
},
{
"type": {
"coding": [
{
"code": "copay-maximum"
}
]
},
"allowedMoney": {
"value": 100,
"currency": "SAR"
}
},
{
"type": {
"coding": [
{
"code": "copay-percent"
}
]
},
"allowedUnsignedInt": 20
}
]
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "69",
"display": "Maternity"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 15000,
"currency": "SAR"
}
}
]
"allowedMoney" : {
"value" : 15000,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F3",
"display" : "Dental Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "F3",
"display": "Dental Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 2000,
"currency": "SAR"
}
}
]
"allowedMoney" : {
"value" : 2000,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "F6",
"display" : "Vision Coverage"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "annual"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "F6",
"display": "Vision Coverage"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "annual"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 400,
"currency": "SAR"
}
}
]
"allowedMoney" : {
"value" : 400,
"currency" : "SAR"
}
}]
},
{
"category" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "49",
"display" : "Hospital Room and Board"
}]
},
"network" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
"code" : "in"
}]
},
"unit" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code" : "individual"
}]
},
"term" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/benefit-term",
"code" : "day"
}]
},
"benefit" : [{
"type" : {
"coding" : [{
"code" : "room"
}]
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code": "49",
"display": "Hospital Room and Board"
}
]
},
"network": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-network",
"code": "in"
}
]
},
"unit": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
"code": "individual"
}
]
},
"term": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/benefit-term",
"code": "day"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"code": "room"
}
]
},
"allowedString": "shared"
},
{
"type": {
"coding": [
{
"code": "benefit"
}
]
},
"allowedMoney": {
"value": 600,
"currency": "SAR"
}
}
]
"allowedString" : "shared"
},
{
"type" : {
"coding" : [{
"code" : "benefit"
}]
},
"allowedMoney" : {
"value" : 600,
"currency" : "SAR"
}
]
}
]
}]
}]
}]
}
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.
FHIR
®©
HL7.org
2011+.
FHIR
Release
4
(Technical
Correction
#1)
(v4.0.1)
R6
hl7.fhir.core#6.0.0-ballot3
generated
on
Fri,
Nov
1,
2019
09:34+1100.
QA
Page
7,
2025
18:58+0000.
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