R4 Ballot #1 #2 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: (v3.5.0: R4 Ballot 2). #2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Coverage-example-2.json

Financial Management Work Group Maturity Level : N/A Ballot Status : Informative Compartments : Patient , RelatedPerson

Raw JSON ( canonical form + also see JSON Format Specification )

General Person Secondary Coverage Example 

{
  "resourceType": "Coverage",
  "id": "7546D",
  "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://hl7.org/fhir/v3/ActCode",

        "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": {
        "system": "http://hl7.org/fhir/coverage-class",

        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",

        "code": "group"
      },
      "value": "WESTAIR",
      "name": "Western Airlines"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-class",

        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",

        "code": "plan"
      },
      "value": "BG4352",
      "name": "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    },
    {
      "type": {
        "system": "http://hl7.org/fhir/coverage-class",

        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",

        "code": "subplan"
      },
      "value": "D15C9",
      "name": "Platinum"
    }
  ],
  "order": 2,
  "network": "5",
  "contract": [
    {
      "reference": "Contract/INS-101"
    }
  ]
}

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.