<Coverage xmlns="http://hl7.org/fhir"><id value="7546D"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</div></text><identifier><system value="http://xyz.com/codes/identifier"/><value value="AB98761"/></identifier><status value="active"/><kind value="insurance"/><type><coding><system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/><code value="EHCPOL"/><display value="extended healthcare"/></coding></type><subscriber><reference value="Patient/5"/></subscriber><subscriberId><value value="AB9876"/></subscriberId><beneficiary><reference value="Patient/5"/></beneficiary><dependent value="1"/><relationship><coding><code value="self"/></coding></relationship><period><start value="2011-03-17"/><end value="2012-03-17"/></period><insurer><reference value="Organization/2"/></insurer><class><type><coding><system value="http://terminology.hl7.org/CodeSystem/coverage-class"/><code value="group"/></coding></type><value><value value="WESTAIR"/></value><name value="Western Airlines"/></class><class><type><coding><system value="http://terminology.hl7.org/CodeSystem/coverage-class"/><code value="plan"/></coding></type><value><value value="BG4352"/></value><name value="Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"/></class><class><type><coding><system value="http://terminology.hl7.org/CodeSystem/coverage-class"/><code value="subplan"/></coding></type><value><value value="D15C9"/></value><name value="Platinum"/></class><order value="2"/><network value="5"/><costToBeneficiary><type><coding><system value="http://terminology.hl7.org/CodeSystem/coverage-copay-type"/><code value="gpvisit"/></coding></type><valueMoney><value value="20.00"/><currency value="USD"/></valueMoney><exception><type><coding><system value="http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception"/><code value="retired"/></coding></type><period><start value="2018-01-01"/><end value="2018-12-31"/></period></exception></costToBeneficiary><contract><reference value="Contract/INS-101"/></contract></Coverage>