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Packagehl7.fhir.us.davinci-drug-formulary.r4
Resource TypeCoverage
IdCoverage-InsurancePlanCoverageExample.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Coverage InsurancePlanCoverageExample

Extension Definition for Coverage.insurancePlan for Version 5.0: InsurancePlan Sample Medicare Advantage Plan A1002

identifier: Member Number/88800933501

status: Active

type: PPO

subscriberId: 888009335

beneficiary: Amy V. Baxter Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))

relationship: Self

period: 2020-01-01 --> (ongoing)

payor: Acme Health Plan

class

type: An employee group

value: xyz

name: XYZ employee Group Plan

class

type: A specific suite of benefits.

value: gold

name: Acme Gold Plan

Source1

{
  "resourceType": "Coverage",
  "id": "InsurancePlanCoverageExample",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/insurance-plan-coverage"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.insurancePlan",
      "valueReference": {
        "reference": "InsurancePlan/PayerInsurancePlanA1002"
      }
    }
  ],
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MB",
            "display": "Member Number"
          }
        ]
      },
      "system": "http://example.org/fhir/memberidentifier",
      "value": "88800933501"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "https://nahdo.org/sopt",
        "code": "3712",
        "display": "PPO"
      },
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "PPO",
        "display": "preferred provider organization policy"
      }
    ],
    "text": "PPO"
  },
  "subscriberId": "888009335",
  "beneficiary": {
    "reference": "Patient/example"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self"
      }
    ],
    "text": "Self"
  },
  "period": {
    "start": "2020-01-01"
  },
  "payor": [
    {
      "reference": "Organization/acme-payer",
      "display": "Acme Health Plan"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "group",
            "display": "Group"
          }
        ],
        "text": "An employee group"
      },
      "value": "xyz",
      "name": "XYZ employee Group Plan"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan",
            "display": "Plan"
          }
        ],
        "text": "A specific suite of benefits."
      },
      "value": "gold",
      "name": "Acme Gold Plan"
    }
  ]
}