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FHIR IG analytics

Packagehl7.fhir.us.insurance-card.r4b
Resource TypeCoverage
IdCoverage-Example-Coverage-FSH.json
FHIR VersionR4B

Resources that use this resource

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Resources that this resource uses

No resources found

Narrative

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

Generated Narrative: Coverage

Resource Coverage "Example-Coverage-FSH" Version "1" Updated "2021-04-06 10:49:02+0000"

Profile: C4DIC Coverage

Plan Beneficiaries

url

memberId

value: 102345672-01

url

name

value: John Doe

Plan Beneficiaries

url

memberId

value: 102345672-02

url

name

value: jane Doe

Plan Beneficiaries

url

memberId

value: 102345672-03

url

name

value: Jimmy Doe

Plan Beneficiaries

url

memberId

value: 102345672-04

url

name

value: Ginny Doe

Additional Insurance Card Information: If you use a TTY, call 711. You may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law. We encourage you to use a primary care physician as a valuable resource and personal health advocate.

Card Issue Date: 2020-12-15

Color Palette

url

Background Color

value: #00bfff (IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB##00bfff)

url

Foreground Color

value: #000000 (IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB##000000)

url

Highlight Color

value: #ceebf5 (IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB##ceebf5)

Logo

url

description

value: Company logo

url

image

value:

url

label

value: ACME Inc.

QR Code

url

description

value: Usage text for this QR code for the end user

url

image

value:

url

label

value: Some label for this QR code

Barcode

url

description

value: Usage text for this Barcode for the end user

url

image

value:

url

label

value: Some label for this Barcode

Supporting image

url

description

value: Some text for the end user about the usage/meaning of this image

url

image

value:

url

label

value: Some label text

identifier: Member Number/102345672-02

status: active

type: health insurance plan policy (ActCode#HIP)

subscriber: Patient/Example-Patient1: John Doe " DOE"

subscriberId: 102345672-01

beneficiary: Patient/Example-Patient2: Jane Doe " DOE"

dependent: 02

relationship: Spouse (SubscriberPolicyholder Relationship Codes#spouse)

period: 2021-01-01 --> (ongoing)

payor: Organization/Example-PayerOrganization1: Acme Insurance Co "Acme Insurance Co"

class

type: Group (Coverage Class Codes#group)

value: 993355

name: Stars Inc

class

type: Plan (Coverage Class Codes#plan)

value: 11461128

name: Acme Gold Plus

class

type: Division (C4DIC Extended Coverage Class#division)

value: 11

class

type: Network (C4DIC Extended Coverage Class#network)

value: 561490

name: Acme Gold Plus South

class

type: RX BIN (Coverage Class Codes#rxbin)

value: 100045

class

type: RX PCN (Coverage Class Codes#rxpcn)

value: 1234000

costToBeneficiary

type: Family Out of Network Deductible (C4DIC Extended Copay Type#FamOutDed)

value: $10,000.00 (USD)

costToBeneficiary

type: Family In Network Deductible (C4DIC Extended Copay Type#FamInDed)

value: $8,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Deductible (C4DIC Extended Copay Type#FamRxOutDed)

value: $2,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Deductible (C4DIC Extended Copay Type#FamRxInDed)

value: $1,500.00 (USD)

costToBeneficiary

type: Family Out of Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamOutMax)

value: $12,000.00 (USD)

costToBeneficiary

type: Family In Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamInMax)

value: $10,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamRxOutMax)

value: $3,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamRxInMax)

value: $2,000.00 (USD)

Source1

{
  "resourceType": "Coverage",
  "id": "Example-Coverage-FSH",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2021-04-06T10:49:02.473+00:00",
    "profile": [
      "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "extension": [
        {
          "url": "memberId",
          "valueString": "102345672-01"
        },
        {
          "url": "name",
          "valueHumanName": {
            "family": "Doe",
            "given": [
              "John"
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
    },
    {
      "extension": [
        {
          "url": "memberId",
          "valueString": "102345672-02"
        },
        {
          "url": "name",
          "valueHumanName": {
            "family": "Doe",
            "given": [
              "jane"
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
    },
    {
      "extension": [
        {
          "url": "memberId",
          "valueString": "102345672-03"
        },
        {
          "url": "name",
          "valueHumanName": {
            "family": "Doe",
            "given": [
              "Jimmy"
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
    },
    {
      "extension": [
        {
          "url": "memberId",
          "valueString": "102345672-04"
        },
        {
          "url": "name",
          "valueHumanName": {
            "family": "Doe",
            "given": [
              "Ginny"
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
    },
    {
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension",
      "valueAnnotation": {
        "text": "If you use a TTY, call 711.\nYou may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law.\nWe encourage you to use a primary care physician as a valuable resource and personal health advocate."
      }
    },
    {
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension",
      "valueDate": "2020-12-15"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/IECColourManagement",
                "code": "#00bfff"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/IECColourManagement",
                "code": "#000000"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/IECColourManagement",
                "code": "#ceebf5"
              }
            ]
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension"
    },
    {
      "extension": [
        {
          "url": "description",
          "valueString": "Company logo"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/png",
            "data": "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"
          }
        },
        {
          "url": "label",
          "valueString": "ACME Inc."
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension"
    },
    {
      "extension": [
        {
          "url": "description",
          "valueString": "Usage text for this QR code for the end user"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/png",
            "data": "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"
          }
        },
        {
          "url": "label",
          "valueString": "Some label for this QR code"
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension"
    },
    {
      "extension": [
        {
          "url": "description",
          "valueString": "Usage text for this Barcode for the end user"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/png",
            "data": "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"
          }
        },
        {
          "url": "label",
          "valueString": "Some label for this Barcode"
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension"
    },
    {
      "extension": [
        {
          "url": "description",
          "valueString": "Some text for the end user about the usage/meaning of this image"
        },
        {
          "url": "image",
          "valueAttachment": {
            "contentType": "image/png",
            "data": "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"
          }
        },
        {
          "url": "label",
          "valueString": "Some label text"
        }
      ],
      "url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"
    }
  ],
  "identifier": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MB",
            "display": "Member Number"
          }
        ]
      },
      "system": "https://www.acmeinsurance.com/glossary/memberid",
      "value": "102345672-02",
      "assigner": {
        "display": "Acme Insurance Co"
      }
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "HIP",
        "display": "health insurance plan policy"
      }
    ],
    "text": "health insurance plan policy"
  },
  "subscriber": {
    "reference": "Patient/Example-Patient1",
    "display": "John Doe"
  },
  "subscriberId": "102345672-01",
  "beneficiary": {
    "reference": "Patient/Example-Patient2",
    "display": "Jane Doe"
  },
  "dependent": "02",
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "spouse",
        "display": "Spouse"
      }
    ],
    "text": "Spouse"
  },
  "period": {
    "start": "2021-01-01"
  },
  "payor": [
    {
      "reference": "Organization/Example-PayerOrganization1",
      "display": "Acme Insurance Co"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "group"
          }
        ]
      },
      "value": "993355",
      "name": "Stars Inc"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan"
          }
        ]
      },
      "value": "11461128",
      "name": "Acme Gold Plus"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS",
            "code": "division"
          }
        ]
      },
      "value": "11"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS",
            "code": "network"
          }
        ]
      },
      "value": "561490",
      "name": "Acme Gold Plus South"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "rxbin"
          }
        ]
      },
      "value": "100045"
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "rxpcn"
          }
        ]
      },
      "value": "1234000"
    }
  ],
  "costToBeneficiary": [
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamOutDed",
            "display": "Family Out of Network Deductible"
          }
        ]
      },
      "valueMoney": {
        "value": 10000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamInDed",
            "display": "Family In Network Deductible"
          }
        ]
      },
      "valueMoney": {
        "value": 8000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamRxOutDed",
            "display": "Family Pharmacy Out of Network Deductible"
          }
        ]
      },
      "valueMoney": {
        "value": 2000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamRxInDed",
            "display": "Family Pharmacy In Network Deductible"
          }
        ]
      },
      "valueMoney": {
        "value": 1500,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamOutMax",
            "display": "Family Out of Network Out of Pocket Maximum"
          }
        ]
      },
      "valueMoney": {
        "value": 12000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamInMax",
            "display": "Family In Network Out of Pocket Maximum"
          }
        ]
      },
      "valueMoney": {
        "value": 10000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamRxOutMax",
            "display": "Family Pharmacy Out of Network Out of Pocket Maximum"
          }
        ]
      },
      "valueMoney": {
        "value": 3000,
        "currency": "USD"
      }
    },
    {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
            "code": "FamRxInMax",
            "display": "Family Pharmacy In Network Out of Pocket Maximum"
          }
        ]
      },
      "valueMoney": {
        "value": 2000,
        "currency": "USD"
      }
    }
  ]
}