---
type: "example"
title: "CoverageEligibilityResponse Example: coverageeligibilityresponse-example-benefits"
resource: "CoverageEligibilityResponse"
example: "coverageeligibilityresponse-example-benefits"
---
# CoverageEligibilityResponse Example: coverageeligibilityresponse-example-benefits

## Narrative

A human-readable rendering of the CoverageEligibilityResponse.

## Example XML



```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>
```