Coverage Example: coverage-example-2

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="7546D"/>

    <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://xyz.com/codes/identifier"/>
        <value value="AB98761"/>
    </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>

    <subscriber>
        <reference value="Patient/5"/>
    </subscriber>

    <subscriberId>
        <value value="AB9876"/>
    </subscriberId>

    <beneficiary>
        <reference value="Patient/5"/>
    </beneficiary>

    <dependent value="1"/>

    <relationship>
        <coding>
            <code value="self"/>
        </coding>	 
    </relationship>

    <period> 
        <start value="2011-03-17"/>
        <end value="2012-03-17"/>
    </period>

    <insurer>
        <reference value="Organization/2"/>
    </insurer>

    <class>
        <type>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                <code value="group"/>
            </coding>
        </type>
        <value>
            <value value="WESTAIR"/>
        </value>
        <name value="Western Airlines"/>
    </class>

    <class>
        <type>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                <code value="plan"/>
            </coding>
        </type>
        <value>
            <value value="BG4352"/>
        </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="D15C9"/>
        </value>
        <name value="Platinum"/>
    </class>

    <order value="2"/> <!-- Second after the national medical coverage -->

    <network value="5"/>

    <costToBeneficiary>
        <type>
            <coding>
                <system value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/>
                <code value="gpvisit"/> <!-- normally $40.00 -->
            </coding>
        </type>
        <valueMoney>
            <value value="20.00"/>
            <currency value="USD"/>
        </valueMoney>
        <exception>
            <type>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception"/>
                    <code value="retired"/>
                </coding>
            </type>
            <period>
                <start value="2018-01-01"/>
                <end value="2018-12-31"/>
            </period>
        </exception>
    </costToBeneficiary>

    <contract>
        <reference value="Contract/INS-101"/>
    </contract>

</Coverage>