<CoverageEligibilityResponse xmlns="http://hl7.org/fhir"><id value="E2501"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityResponse.</div></text><identifier><system value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse"/><value value="881234"/></identifier><status value="active"/><purpose value="validation"/><purpose value="benefits"/><patient><reference value="Patient/pat1"/></patient><servicedDate value="2014-09-17"/><created value="2014-08-16"/><request><reference value="http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332402"/></request><outcome value="complete"/><disposition value="Policy is currently in-force."/><insurer><reference value="Organization/2"/></insurer><insurance><coverage><reference value="Coverage/9876B1"/></coverage><inforce value="true"/><item><category><coding><system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/><code value="30"/><display value="Health Benefit Plan Coverage"/></coding></category><network><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-network"/><code value="in"/></coding></network><unit><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/><code value="individual"/></coding></unit><term><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-term"/><code value="annual"/></coding></term><benefit><type><coding><code value="benefit"/></coding></type><allowedMoney><value value="500000"/><currency value="SAR"/></allowedMoney></benefit><benefit><type><coding><code value="copay-maximum"/></coding></type><allowedMoney><value value="100"/><currency value="SAR"/></allowedMoney></benefit><benefit><type><coding><code value="copay-percent"/></coding></type><allowedUnsignedInt value="20"/></benefit></item><item><category><coding><system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/><code value="69"/><display value="Maternity"/></coding></category><network><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-network"/><code value="in"/></coding></network><unit><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/><code value="individual"/></coding></unit><term><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-term"/><code value="annual"/></coding></term><benefit><type><coding><code value="benefit"/></coding></type><allowedMoney><value value="15000"/><currency value="SAR"/></allowedMoney></benefit></item><item><category><coding><system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/><code value="F3"/><display value="Dental Coverage"/></coding></category><network><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-network"/><code value="in"/></coding></network><unit><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/><code value="individual"/></coding></unit><term><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-term"/><code value="annual"/></coding></term><benefit><type><coding><code value="benefit"/></coding></type><allowedMoney><value value="2000"/><currency value="SAR"/></allowedMoney></benefit></item><item><category><coding><system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/><code value="F6"/><display value="Vision Coverage"/></coding></category><network><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-network"/><code value="in"/></coding></network><unit><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/><code value="individual"/></coding></unit><term><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-term"/><code value="annual"/></coding></term><benefit><type><coding><code value="benefit"/></coding></type><allowedMoney><value value="400"/><currency value="SAR"/></allowedMoney></benefit></item><item><category><coding><system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/><code value="49"/><display value="Hospital Room and Board"/></coding></category><network><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-network"/><code value="in"/></coding></network><unit><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-unit"/><code value="individual"/></coding></unit><term><coding><system value="http://terminology.hl7.org/CodeSystem/benefit-term"/><code value="day"/></coding></term><benefit><type><coding><code value="room"/></coding></type><allowedString value="shared"/></benefit><benefit><type><coding><code value="benefit"/></coding></type><allowedMoney><value value="600"/><currency value="SAR"/></allowedMoney></benefit></item></insurance></CoverageEligibilityResponse>