BSeR: Bidirectional Services_eReferral
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: coverage-BSeR-Coverage-eve-everywoman - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "coverage-BSeR-Coverage-eve-everywoman",
  "meta" : {
    "versionId" : "3",
    "lastUpdated" : "2023-03-31T04:46:33.263+00:00",
    "source" : "#inkCoxzgZSNurkBt",
    "profile" : [
      "http://hl7.org/fhir/us/bser/StructureDefinition/BSeR-Coverage"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"coverage-BSeR-Coverage-eve-everywoman\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage &quot;coverage-BSeR-Coverage-eve-everywoman&quot; Version &quot;3&quot; Updated &quot;2023-03-31 04:46:33+0000&quot; </p><p style=\"margin-bottom: 0px\">Information Source: #inkCoxzgZSNurkBt!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-BSeR-Coverage.html\">BSeR Coverage</a></p></div><p><b>identifier</b>: id:\u00a012345</p><p><b>status</b>: active</p><p><b>type</b>: extended healthcare <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActCode.html\">ActCode</a>#EHCPOL)</span></p><p><b>subscriber</b>: <a href=\"RelatedPerson-relatedperson-self-eve-everywoman.html\">RelatedPerson/relatedperson-self-eve-everywoman: Eve Everywoman</a> &quot; EVERYWOMAN&quot;</p><p><b>beneficiary</b>: <a href=\"Patient-patient-us-core-patient-eve-everywoman.html\">Patient/patient-us-core-patient-eve-everywoman: Eve Everywoman</a> &quot; EVERYWOMAN&quot;</p><p><b>relationship</b>: self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-v3-RoleCode.html\">RoleCode</a>#ONESELF)</span></p><p><b>period</b>: 2019-05-23 --&gt; 2020-05-23</p><p><b>payor</b>: <a href=\"Organization-organization-bser-organization-saint-luke.html\">Organization/organization-bser-organization-saint-luke</a> &quot;Saint Luke's Hospital of Kansas City&quot;</p><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: CB135</p><p><b>name</b>: Corporate Baker's Inc. Local #35</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: SubGroup <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#subgroup)</span></p><p><b>value</b>: 123</p><p><b>name</b>: Trainee Part-time Benefits</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan)</span></p><p><b>value</b>: B37FC</p><p><b>name</b>: Full Coverage: Medical, Dental, Pharmacy, Vision, EHC</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: SubPlan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#subplan)</span></p><p><b>value</b>: P7</p><p><b>name</b>: Includes afterlife benefits</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Class <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#class)</span></p><p><b>value</b>: SILVER</p><p><b>name</b>: Silver: Family Plan spouse only</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: SubClass <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#subclass)</span></p><p><b>value</b>: Tier2</p><p><b>name</b>: Low deductable, max $20 copay</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Sequence <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#sequence)</span></p><p><b>value</b>: 9</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: RX Id <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxid)</span></p><p><b>value</b>: MDF12345</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: RX BIN <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxbin)</span></p><p><b>value</b>: 987654</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: RX Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxgroup)</span></p><p><b>value</b>: M35PT</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: RX PCN <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#rxpcn)</span></p><p><b>value</b>: 234516</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Sequence <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#sequence)</span></p><p><b>value</b>: 9</p></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "subscriber" : {
    "reference" : "RelatedPerson/relatedperson-self-eve-everywoman",
    "display" : "Eve Everywoman"
  },
  "beneficiary" : {
    "reference" : "Patient/patient-us-core-patient-eve-everywoman",
    "display" : "Eve Everywoman"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "code" : "ONESELF",
        "display" : "self"
      }
    ],
    "text" : "self"
  },
  "period" : {
    "start" : "2019-05-23",
    "end" : "2020-05-23"
  },
  "payor" : [
    {
      "reference" : "Organization/organization-bser-organization-saint-luke"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "CB135",
      "name" : "Corporate Baker's Inc. Local #35"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subgroup"
          }
        ]
      },
      "value" : "123",
      "name" : "Trainee Part-time Benefits"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan"
          }
        ]
      },
      "value" : "B37FC",
      "name" : "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subplan"
          }
        ]
      },
      "value" : "P7",
      "name" : "Includes afterlife benefits"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "class"
          }
        ]
      },
      "value" : "SILVER",
      "name" : "Silver: Family Plan spouse only"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "subclass"
          }
        ]
      },
      "value" : "Tier2",
      "name" : "Low deductable, max $20 copay"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "sequence"
          }
        ]
      },
      "value" : "9"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxid"
          }
        ]
      },
      "value" : "MDF12345"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxbin"
          }
        ]
      },
      "value" : "987654"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxgroup"
          }
        ]
      },
      "value" : "M35PT"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "rxpcn"
          }
        ]
      },
      "value" : "234516"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "sequence"
          }
        ]
      },
      "value" : "9"
    }
  ]
}