---
type: "example"
title: "Coverage Example: coverage-example"
resource: "Coverage"
example: "coverage-example"
---
# Coverage Example: coverage-example

## Narrative

A human-readable rendering of the coverage

## Example XML



```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>
```