Coverage Example: coverage-example

Narrative

A human-readable rendering of the coverage

Example XML

<?xml version="1.0" encoding="UTF-8"?>
<Coverage xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/coverage.xsd">
    <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://benefits.example.org/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>