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Source1

{
  "resourceType": "Coverage",
  "id": "coverage1001",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Coverage.kind",
      "valueCode": "insurance"
    }
  ],
  "status": "active",
  "subscriberId": "PFP123450000",
  "beneficiary": {
    "reference": "Patient/patient1001"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self",
        "display": "Self"
      }
    ]
  },
  "period": {
    "start": "2021-01-01",
    "end": "2022-01-01"
  },
  "payor": [
    {
      "reference": "Organization/org1001"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan",
            "display": "Plan"
          }
        ]
      },
      "value": "Premim Family Plus",
      "name": "Premim Family Plus Plan"
    }
  ],
  "costToBeneficiary": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
            "code": "copaypct",
            "display": "Copay Percentage"
          }
        ]
      },
      "valueQuantity": {
        "value": 20
      }
    }
  ]
}