Release 4B 5

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0: R5 - STU ). The This is the current published version which supercedes in it's permanent home (it will always be available at this version is 5.0.0 . URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R5 R4B R4

Coverageeligibilityresponse-example-benefits-2.ttl

Example CoverageEligibilityResponse/E2502 (Turtle)

Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Patient , Practitioner

Raw Turtle (+ also see Turtle/RDF Format Specification )

General Person Primary Coverage with Benefit Details and new insurance 

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/CoverageEligibilityResponse/E2502> a fhir:CoverageEligibilityResponse;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "E2502"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  ];
  fhir:DomainResource.contained [
     a fhir:Coverage;
     fhir:index 0;
     fhir:Resource.id [ fhir:value "coverage-1" ];
     fhir:Coverage.identifier [
       fhir:index 0;
       fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
       fhir:Identifier.value [ fhir:value "12345" ]
     ];
     fhir:Coverage.status [ fhir:value "active" ];
     fhir:Coverage.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
         fhir:Coding.code [ fhir:value "EHCPOL" ]
       ]
     ];
     fhir:Coverage.subscriber [
       fhir:link <http://hl7.org/fhir/Patient/f201>;
       fhir:Reference.reference [ fhir:value "Patient/f201" ]
     ];
     fhir:Coverage.beneficiary [
       fhir:link <http://hl7.org/fhir/Patient/f201>;
       fhir:Reference.reference [ fhir:value "Patient/f201" ]
     ];
     fhir:Coverage.dependent [ fhir:value "1" ];
     fhir:Coverage.relationship [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "self" ]

[a fhir:CoverageEligibilityResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "E2502"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the CoverageEligibilityResponse.</div>"
  ] ; # 
  fhir:contained ( [
     a fhir:Coverage ;
     fhir:id [ fhir:v "coverage-1" ] ;
     fhir:identifier ( [
       fhir:system [ fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "12345" ]
     ] ) ;
     fhir:status [ fhir:v "active" ] ;
     fhir:kind [ fhir:v "insurance" ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "EHCPOL" ]
       ] )
     ] ;
     fhir:subscriber [
       fhir:reference [ fhir:v "Patient/f201" ]
     ] ;
     fhir:beneficiary [
       fhir:reference [ fhir:v "Patient/f201" ]
     ] ;
     fhir:dependent [ fhir:v "1" ] ;
     fhir:relationship [
       fhir:coding ( [
         fhir:code [ fhir:v "self" ]
       ] )
     ] ;
     fhir:insurer [
       fhir:identifier [
         fhir:system [ fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "123456" ]

       ]
     ];
     fhir:Coverage.payor [
       fhir:index 0;
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
         fhir:Identifier.value [ fhir:value "123456" ]

     ] ;
     fhir:class ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "EHCPOL" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "CBI35" ]
       ] ;
       fhir:name [ fhir:v "Corporate Baker's Inc. Plan#35" ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "subplan" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "123" ]
       ] ;
       fhir:name [ fhir:v "Trainee Part-time Benefits" ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "sequence" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "1" ]

       ]
     ];
     fhir:Coverage.class [
       fhir:index 0;
       fhir:Coverage.class.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
           fhir:Coding.code [ fhir:value "EHCPOL" ]
         ]
       ];
       fhir:Coverage.class.value [ fhir:value "CBI35" ];
       fhir:Coverage.class.name [ fhir:value "Corporate Baker's Inc. Plan#35" ]
     ], [
       fhir:index 1;
       fhir:Coverage.class.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
           fhir:Coding.code [ fhir:value "subplan" ]
         ]
       ];
       fhir:Coverage.class.value [ fhir:value "123" ];
       fhir:Coverage.class.name [ fhir:value "Trainee Part-time Benefits" ]
     ], [
       fhir:index 2;
       fhir:Coverage.class.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
           fhir:Coding.code [ fhir:value "sequence" ]
         ]
       ];
       fhir:Coverage.class.value [ fhir:value "1" ]
     ]
  ];
  fhir:CoverageEligibilityResponse.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse" ];
     fhir:Identifier.value [ fhir:value "8812342" ]
  ];
  fhir:CoverageEligibilityResponse.status [ fhir:value "active"];
  fhir:CoverageEligibilityResponse.purpose [
     fhir:value "validation";
     fhir:index 0
  ], [
     fhir:value "benefits";
     fhir:index 1
  ];
  fhir:CoverageEligibilityResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/f201>;
     fhir:Reference.reference [ fhir:value "Patient/f201" ]
  ];
  fhir:CoverageEligibilityResponse.created [ fhir:value "2014-09-16"^^xsd:date];
  fhir:CoverageEligibilityResponse.requestor [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://national.org/clinic" ];
       fhir:Identifier.value [ fhir:value "OR1234" ]

     ] )
  ] ) ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "8812342" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:purpose ( [ fhir:v "validation"] [ fhir:v "benefits"] ) ; # 
  fhir:patient [
     fhir:reference [ fhir:v "Patient/f201" ]
  ] ; # 
  fhir:created [ fhir:v "2014-09-16"^^xsd:date] ; # 
  fhir:requestor [
     fhir:identifier [
       fhir:system [ fhir:v "http://national.org/clinic"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "OR1234" ]

     ]
  ];
  fhir:CoverageEligibilityResponse.request [
     fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405>;
     fhir:Reference.reference [ fhir:value "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405" ]
  ];
  fhir:CoverageEligibilityResponse.outcome [ fhir:value "complete"];
  fhir:CoverageEligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
  fhir:CoverageEligibilityResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:CoverageEligibilityResponse.insurance [
     fhir:index 0;
     fhir:CoverageEligibilityResponse.insurance.coverage [
       fhir:Reference.reference [ fhir:value "#coverage-1" ]
     ];
     fhir:CoverageEligibilityResponse.insurance.inforce [ fhir:value "true"^^xsd:boolean ];
     fhir:CoverageEligibilityResponse.insurance.item [
       fhir:index 0;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "30" ];
           fhir:Coding.display [ fhir:value "Health Benefit Plan Coverage" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "500000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "USD" ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.usedMoney [
           fhir:Money.value [ fhir:value "3748.00"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "USD" ]
         ]
       ], [
         fhir:index 1;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-maximum" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "100"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "USD" ]
         ]
       ], [
         fhir:index 2;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "copay-percent" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]
       ]
     ], [
       fhir:index 1;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "69" ];
           fhir:Coding.display [ fhir:value "Maternity" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "15000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "USD" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "F3" ];
           fhir:Coding.display [ fhir:value "Dental Coverage" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.network [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-network" ];
           fhir:Coding.code [ fhir:value "in" ]
         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.unit [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-unit" ];
           fhir:Coding.code [ fhir:value "individual" ]

  ] ; # 
  fhir:request [
     fhir:link <http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405> ;
     fhir:reference [ fhir:v "http://www.BenefitsInc.com/fhir/coverageeligibilityrequest/225476332405" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Policy is currently in-force."] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:insurance ( [
     fhir:coverage [
       fhir:reference [ fhir:v "#coverage-1" ]
     ] ;
     fhir:inforce [ fhir:v "true"^^xsd:boolean ] ;
     fhir:item ( [
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "30" ] ;
           fhir:display [ fhir:v "Health Benefit Plan Coverage" ]
         ] )
       ] ;
       fhir:network [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "in" ]
         ] )
       ] ;
       fhir:unit [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "individual" ]
         ] )
       ] ;
       fhir:term [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "annual" ]
         ] )
       ] ;
       fhir:benefit ( [
         fhir:type [
           fhir:coding ( [
             fhir:code [ fhir:v "benefit" ]
           ] )
         ] ;
         fhir:allowed [
           a fhir:Money ;
           fhir:value [ fhir:v "500000"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:used [
           a fhir:Money ;
           fhir:value [ fhir:v "3748.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]

         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.term [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-term" ];
           fhir:Coding.code [ fhir:value "annual" ]

       ] [
         fhir:type [
           fhir:coding ( [
             fhir:code [ fhir:v "copay-maximum" ]
           ] )
         ] ;
         fhir:allowed [
           a fhir:Money ;
           fhir:value [ fhir:v "100"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]

         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.code [ fhir:value "benefit" ]
           ]
         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "2000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "USD" ]

       ] [
         fhir:type [
           fhir:coding ( [
             fhir:code [ fhir:v "copay-percent" ]
           ] )
         ] ;
         fhir:allowed [ fhir:v "20"^^xsd:nonNegativeInteger ]
       ] )
     ] [
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "69" ] ;
           fhir:display [ fhir:v "Maternity" ]
         ] )
       ] ;
       fhir:network [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "in" ]
         ] )
       ] ;
       fhir:unit [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "individual" ]
         ] )
       ] ;
       fhir:term [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "annual" ]
         ] )
       ] ;
       fhir:benefit ( [
         fhir:type [
           fhir:coding ( [
             fhir:code [ fhir:v "benefit" ]
           ] )
         ] ;
         fhir:allowed [
           a fhir:Money ;
           fhir:value [ fhir:v "15000"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]

         ]
       ]
     ], [
       fhir:index 3;
       fhir:CoverageEligibilityResponse.insurance.item.category [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ];
           fhir:Coding.code [ fhir:value "F6" ];
           fhir:Coding.display [ fhir:value "Vision Coverage" ]

       ] )
     ] [
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "F3" ] ;
           fhir:display [ fhir:v "Dental Coverage" ]
         ] )
       ] ;
       fhir:network [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-network"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "in" ]
         ] )
       ] ;
       fhir:unit [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "individual" ]
         ] )
       ] ;
       fhir:term [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "annual" ]
         ] )
       ] ;
       fhir:benefit ( [
         fhir:type [
           fhir:coding ( [
             fhir:code [ fhir:v "benefit" ]
           ] )
         ] ;
         fhir:allowed [
           a fhir:Money ;
           fhir:value [ fhir:v "2000"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]

         ]
       ];
       fhir:CoverageEligibilityResponse.insurance.item.excluded [ fhir:value "true"^^xsd:boolean ];
       fhir:CoverageEligibilityResponse.insurance.item.name [ fhir:value "Vision" ];
       fhir:CoverageEligibilityResponse.insurance.item.description [ fhir:value "Vision products and services such as exams, glasses and contact lenses." ]
     ]
  ];
  fhir:CoverageEligibilityResponse.form [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://national.org/form" ];
       fhir:Coding.code [ fhir:value "ELRSP/2017/01" ]
     ]
  ] .

<http://hl7.org/fhir/Patient/f201> a fhir:Patient .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/CoverageEligibilityResponse/E2502.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/CoverageEligibilityResponse/E2502.ttl> .

       ] )
     ] [
       fhir:category [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-benefitcategory"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "F6" ] ;
           fhir:display [ fhir:v "Vision Coverage" ]
         ] )
       ] ;
       fhir:excluded [ fhir:v "true"^^xsd:boolean ] ;
       fhir:name [ fhir:v "Vision" ] ; #   this benefit category is not covered under the plan  
       fhir:description [ fhir:v "Vision products and services such as exams, glasses and contact lenses." ]
     ] )
  ] ) ; # 
  fhir:form [
     fhir:coding ( [
       fhir:system [ fhir:v "http://national.org/form"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "ELRSP/2017/01" ]
     ] )
  ]] . # 


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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.