CoverageEligibilityResponse Example: coverageeligibilityresponse-example-benefits

Narrative

A human-readable rendering of the CoverageEligibilityResponse.

Example XML

<CoverageEligibilityResponse xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
    <id value="E2501"/>

    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityResponse.</div>
    </text>

    <identifier>
        <system value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"/>
        <value value="881234"/>
    </identifier>

    <status value="active"/>

    <purpose value="validation"/>
    <purpose value="benefits"/>

    <patient>
        <reference value="Patient/pat1"/>
    </patient>

    <servicedDate value="2014-09-17"/> <!-- Anticipated service date -->

    <created value="2014-08-16"/>

    <request>
        <reference value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"/>
    </request>

    <outcome value="complete"/>

    <disposition value="Policy is currently in-force."/>

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

    <insurance>
        <coverage>
            <reference value="Coverage/9876B1"/>
        </coverage>
        <inforce value="true"/>

        <item>
            <category>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                    <code value="30"/>
                    <display value="Health Benefit Plan Coverage"/>
                </coding>
            </category>

            <network>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                    <code value="in"/>
                </coding>
            </network>

            <unit>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                    <code value="individual"/>
                </coding>
            </unit>

            <term>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                    <code value="annual"/>
                </coding>
            </term>

            <benefit>
                <type>
                    <coding>
                        <code value="benefit"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="500000"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

            <benefit>
                <type>
                    <coding>
                        <code value="copay-maximum"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="100"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

            <benefit>
                <type>
                    <coding>
                        <code value="copay-percent"/>
                    </coding>
                </type>

                <allowedUnsignedInt value="20"/>
            </benefit>
        </item>

        <item>
            <category>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                    <code value="69"/>
                    <display value="Maternity"/>
                </coding>
            </category>

            <network>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                    <code value="in"/>
                </coding>
            </network>

            <unit>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                    <code value="individual"/>
                </coding>
            </unit>

            <term>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                    <code value="annual"/>
                </coding>
            </term>

            <benefit>
                <type>
                    <coding>
                        <code value="benefit"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="15000"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

        </item>
        <item>
            <category>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                    <code value="F3"/>
                    <display value="Dental Coverage"/>
                </coding>
            </category>

            <network>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                    <code value="in"/>
                </coding>
            </network>

            <unit>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                    <code value="individual"/>
                </coding>
            </unit>

            <term>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                    <code value="annual"/>
                </coding>
            </term>

            <benefit>
                <type>
                    <coding>
                        <code value="benefit"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="2000"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

        </item>
        <item>
            <category>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                    <code value="F6"/>
                    <display value="Vision Coverage"/>
                </coding>
            </category>

            <network>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                    <code value="in"/>
                </coding>
            </network>

            <unit>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                    <code value="individual"/>
                </coding>
            </unit>

            <term>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                    <code value="annual"/>
                </coding>
            </term>

            <benefit>
                <type>
                    <coding>
                        <code value="benefit"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="400"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

        </item>
        <item>
            <category>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                    <code value="49"/>
                    <display value="Hospital Room and Board"/>
                </coding>
            </category>

            <network>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
                    <code value="in"/>
                </coding>
            </network>

            <unit>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/>
                    <code value="individual"/>
                </coding>
            </unit>

            <term>
                <coding>
                    <system value="http://terminology.hl7.org/CodeSystem/benefit-term"/>
                    <code value="day"/>
                </coding>
            </term>

            <benefit>
                <type>
                    <coding>
                        <code value="room"/>
                    </coding>
                </type>

                <allowedString value="shared"/>
            </benefit>
            <benefit>
                <type>
                    <coding>
                        <code value="benefit"/>
                    </coding>
                </type>

                <allowedMoney>
                    <value value="600"/>
                    <currency value="SAR"/> 
                </allowedMoney>
            </benefit>

        </item>
    </insurance>

</CoverageEligibilityResponse>