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Source1

{
  "resourceType": "Coverage",
  "id": "coverage-2",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MB"
          }
        ]
      },
      "system": "http://example.org/old-payer",
      "value": "DH10001235"
    }
  ],
  "status": "draft",
  "subscriberId": "9876543789",
  "beneficiary": {
    "reference": "Patient/2"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self"
      }
    ]
  },
  "period": {
    "start": "2011-05-23",
    "end": "2012-05-23"
  },
  "payor": [
    {
      "identifier": {
        "system": "http://hl7.org/fhir/sid/us-npi",
        "value": "9876543210"
      },
      "display": "Old Health Plan"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "group"
          },
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "subplan"
          }
        ]
      },
      "value": "P7"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan"
          },
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "class"
          }
        ]
      },
      "value": "SILVER"
    }
  ]
}