General Person Primary Coverage Example (id = "9876B1")

<?xml version="1.0" encoding="UTF-8"?>


  

  
    
    
  

  
    
    
  

  

  
    
      
      
      
    
  

  
    
  

  
    
  

  
    
  
   
  
    
      
    
  

   
    
    
  

  
    
  

  
  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
    
  

  
    
      
        
        
      
    
    
  

  <!--   the following RX class values may be used when pharmacy claims under this coverage are
   sent to a pharmacy claim only processor   -->
  
    
      
        
        
      
    
    
  

  
    
      
        
        
      
    
    
  

  
    
      
        
        
      
    
    
  

  
    
      
        
        
      
    
    
  

  
    
      
        
        
      
    
    
  


<Coverage xmlns="http://hl7.org/fhir">
  <id value="9876B1"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</div> 
  </text> 
  <identifier> 
    <system value="http://benefitsinc.com/certificate"/> 
    <value value="12345"/> 
  </identifier> 
  <status value="active"/> 
  <kind value="insurance"/> 
  <type> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
      <code value="EHCPOL"/> 
      <display value="extended healthcare"/> 
    </coding> 
  </type> 
  
  <policyHolder>     <reference value="http://benefitsinc.com/FHIR/Organization/CBI35"/>   </policyHolder>   <subscriber>     <reference value="Patient/4"/>   </subscriber>   <beneficiary>     <reference value="Patient/4"/>   </beneficiary>   <dependent value="0"/>   <relationship>     <coding>       <code value="self"/>     </coding>   </relationship>   <period>      <start value="2011-05-23"/>     <end value="2012-05-23"/>   </period>   <insurer>     <reference value="Organization/2"/>   </insurer>     <!--   The repeating 'class' element is proposed to replace the 'grouping' element 

    -->
  <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="group"/>       </coding>     </type>     <value>       <value value="CB135"/>     </value>     <name value="Corporate Baker's Inc. Local #35"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="subgroup"/>       </coding>     </type>     <value>       <value value="123"/>     </value>     <name value="Trainee Part-time Benefits"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="plan"/>       </coding>     </type>     <value>       <value value="B37FC"/>     </value>     <name value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="subplan"/>       </coding>     </type>     <value>       <value value="P7"/>     </value>     <name value="Includes afterlife benefits"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="class"/>       </coding>     </type>     <value>       <value value="SILVER"/>     </value>     <name value="Silver: Family Plan spouse only"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="subclass"/>       </coding>     </type>     <value>       <value value="Tier2"/>     </value>     <name value="Low deductable, max $20 copay"/>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="sequence"/>       </coding>     </type>     <value>       <value value="9"/>     </value>   </class>     <!--   the following RX class values may be used when pharmacy claims under this coverage

   are sent to a pharmacy claim only processor   -->
  <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="rxid"/>       </coding>     </type>     <value>       <value value="MDF12345"/>    <!--   member id used when submitting pharmacy claims   -->    </value>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="rxbin"/>       </coding>     </type>     <value>       <value value="987654"/>    <!--   the pharmacy processor BIN number used when submitting pharmacy claims   -->    </value>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="rxgroup"/>       </coding>     </type>     <value>       <value value="M35PT"/>    <!--   group used when submitting pharmacy claims   -->    </value>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="rxpcn"/>       </coding>     </type>     <value>       <value value="234516"/>    <!--   the PCN number used when submitting pharmacy claims   -->    </value>   </class>   <class>     <type>       <coding>         <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>         <code value="sequence"/>       </coding>     </type>     <value>       <value value="9"/>    <!--   the sequence number for a short-term continuance of the coverage   -->    </value>   </class> 


</

Coverage

>