CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot
CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot
CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- <http://hl7.org/fhir/Coverage/Example-Coverage-FSH> a fhir:Coverage ; fhir:nodeRole fhir:treeRoot ; fhir:Resource.id [ fhir:value "Example-Coverage-FSH"] ; fhir:Resource.meta [ fhir:Meta.versionId [ fhir:value "1" ] ; fhir:Meta.lastUpdated [ fhir:value "2021-04-06T10:49:02.473+00:00"^^xsd:dateTime ] ; fhir:Meta.profile [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage" ; fhir:index 0 ; fhir:link <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage> ] ] ; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "extensions" ] ; fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage Example-Coverage-FSH</b></p><a name=\"Example-Coverage-FSH\"> </a><a name=\"hcExample-Coverage-FSH\"> </a><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\">version: 1; Last updated: 2021-04-06 10:49:02+0000</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-C4DIC-Coverage.html\">C4DIC Coverage</a></p></div><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-01</li><li>name: John Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-02</li><li>name: jane Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-03</li><li>name: Jimmy Doe </li></ul></blockquote><blockquote><p><b>Plan Beneficiaries</b></p><ul><li>memberId: 102345672-04</li><li>name: Ginny Doe </li></ul></blockquote><p><b>Additional Insurance Card Information</b>: </p><blockquote><div><p>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.</p>\n</div></blockquote><p><b>Additional Insurance Card Information</b>: <a href=\"InsurancePlan-SBCExampleHMO.html\">Summary of Benefits and Coverage - Acme Gold Plus HMO</a></p><p><b>Card Issue Date</b>: 2020-12-15</p><blockquote><p><b>Color Palette</b></p><ul><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #00bfff}\">#00bfff</span></li><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #000000}\">#000000</span></li><li>http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/IECColourManagement #ceebf5}\">#ceebf5</span></li></ul></blockquote><blockquote><p><b>Logo</b></p><ul><li>description: Company logo</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: ACME Inc.</li></ul></blockquote><blockquote><p><b>QR Code</b></p><ul><li>description: Usage text for this QR code for the end user</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: Some label for this QR code</li></ul></blockquote><blockquote><p><b>Barcode</b></p><ul><li>description: Usage text for this Barcode for the end user</li><li>image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...</li><li>label: Some label for this Barcode</li></ul></blockquote><blockquote><p><b>Supporting image</b></p><ul><li>description: Image of the front of the member's physical insurance card showing plan name, member ID, and group number</li><li>image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...</li><li>label: Front of insurance card</li></ul></blockquote><blockquote><p><b>Supporting image</b></p><ul><li>description: Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information</li><li>image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...</li><li>label: Back of insurance card</li></ul></blockquote><p><b>identifier</b>: Member Number/102345672-02</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Patient-Example-Patient1.html\">John Doe</a></p><p><b>subscriberId</b>: 102345672-01</p><p><b>beneficiary</b>: <a href=\"Patient-Example-Patient2.html\">Jane Doe</a></p><p><b>dependent</b>: 02</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship spouse}\">Spouse</span></p><p><b>period</b>: 2021-01-01 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-Example-PayerOrganization1.html\">Acme Insurance Co</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: 993355</p><p><b>name</b>: Stars Inc</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: 11461128</p><p><b>name</b>: Acme Gold Plus</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS division}\">Division</span></p><p><b>value</b>: 11</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS network}\">Network</span></p><p><b>value</b>: 561490</p><p><b>name</b>: Acme Gold Plus South</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}\">RX BIN</span></p><p><b>value</b>: 100045</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}\">RX PCN</span></p><p><b>value</b>: 1234000</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamOutDed}\">Family Out of Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$10,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamInDed}\">Family In Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$8,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxOutDed}\">Family Pharmacy Out of Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$2,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxInDed}\">Family Pharmacy In Network Deductible</span></p><p><b>value</b>: <span title=\"US Dollar\">$1,500.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamOutMax}\">Family Out of Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$12,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamInMax}\">Family In Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$10,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxOutMax}\">Family Pharmacy Out of Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$3,000.00</span> (USD)</p></blockquote><blockquote><p><b>costToBeneficiary</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS FamRxInMax}\">Family Pharmacy In Network Out of Pocket Maximum</span></p><p><b>value</b>: <span title=\"US Dollar\">$2,000.00</span> (USD)</p></blockquote></div>" ] ; fhir:DomainResource.extension [ fhir:index 0 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "memberId" ] ; fhir:Extension.valueString [ fhir:value "102345672-01" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueHumanName [ fhir:HumanName.family [ fhir:value "Doe" ] ; fhir:HumanName.given [ fhir:value "John" ; fhir:index 0 ] ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ] ], [ fhir:index 1 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "memberId" ] ; fhir:Extension.valueString [ fhir:value "102345672-02" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueHumanName [ fhir:HumanName.family [ fhir:value "Doe" ] ; fhir:HumanName.given [ fhir:value "jane" ; fhir:index 0 ] ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ] ], [ fhir:index 2 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "memberId" ] ; fhir:Extension.valueString [ fhir:value "102345672-03" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueHumanName [ fhir:HumanName.family [ fhir:value "Doe" ] ; fhir:HumanName.given [ fhir:value "Jimmy" ; fhir:index 0 ] ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ] ], [ fhir:index 3 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "memberId" ] ; fhir:Extension.valueString [ fhir:value "102345672-04" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueHumanName [ fhir:HumanName.family [ fhir:value "Doe" ] ; fhir:HumanName.given [ fhir:value "Ginny" ; fhir:index 0 ] ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension" ] ], [ fhir:index 4 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension" ] ; fhir:Extension.valueAnnotation [ fhir:Annotation.text [ fhir:value "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." ] ] ], [ fhir:index 5 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension" ] ; fhir:Extension.valueReference [ fhir:link <http://hl7.org/fhir/InsurancePlan/SBCExampleHMO> ; fhir:Reference.reference [ fhir:value "InsurancePlan/SBCExampleHMO" ] ; fhir:Reference.display [ fhir:value "Summary of Benefits and Coverage - Acme Gold Plus HMO" ] ] ], [ fhir:index 6 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension" ] ; fhir:Extension.valueDate [ fhir:value "2020-12-15"^^xsd:date ] ], [ fhir:index 7 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension" ] ; fhir:Extension.valueCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ; fhir:Coding.code [ fhir:value "#00bfff" ] ] ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension" ] ; fhir:Extension.valueCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ; fhir:Coding.code [ fhir:value "#000000" ] ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension" ] ; fhir:Extension.valueCodeableConcept [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/IECColourManagement" ] ; fhir:Coding.code [ fhir:value "#ceebf5" ] ] ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension" ] ], [ fhir:index 8 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "Company logo" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "image" ] ; fhir:Extension.valueAttachment [ fhir:Attachment.contentType [ fhir:value "image/png" ] ; fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "label" ] ; fhir:Extension.valueString [ fhir:value "ACME Inc." ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension" ] ], [ fhir:index 9 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "Usage text for this QR code for the end user" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "image" ] ; fhir:Extension.valueAttachment [ fhir:Attachment.contentType [ fhir:value "image/png" ] ; fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "label" ] ; fhir:Extension.valueString [ fhir:value "Some label for this QR code" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension" ] ], [ fhir:index 10 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "Usage text for this Barcode for the end user" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "image" ] ; fhir:Extension.valueAttachment [ fhir:Attachment.contentType [ fhir:value "image/png" ] ; fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "label" ] ; fhir:Extension.valueString [ fhir:value "Some label for this Barcode" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension" ] ], [ fhir:index 11 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "Image of the front of the member's physical insurance card showing plan name, member ID, and group number" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "image" ] ; fhir:Extension.valueAttachment [ fhir:Attachment.contentType [ fhir:value "image/jpeg" ] ; fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "label" ] ; fhir:Extension.valueString [ fhir:value "Front of insurance card" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension" ] ], [ fhir:index 12 ; fhir:Element.extension [ fhir:index 0 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information" ] ], [ fhir:index 1 ; fhir:Extension.url [ fhir:value "image" ] ; fhir:Extension.valueAttachment [ fhir:Attachment.contentType [ fhir:value "image/jpeg" ] ; fhir:Attachment.data [ fhir:value "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"^^xsd:base64Binary ] ] ], [ fhir:index 2 ; fhir:Extension.url [ fhir:value "label" ] ; fhir:Extension.valueString [ fhir:value "Back of insurance card" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension" ] ] ; fhir:Coverage.identifier [ fhir:index 0 ; fhir:Identifier.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ] ; fhir:Coding.code [ fhir:value "MB" ] ; fhir:Coding.display [ fhir:value "Member Number" ] ] ] ; fhir:Identifier.system [ fhir:value "https://www.acmeinsurance.com/glossary/memberid" ] ; fhir:Identifier.value [ fhir:value "102345672-02" ] ; fhir:Identifier.assigner [ fhir:Reference.display [ fhir:value "Acme Insurance Co" ] ] ] ; fhir:Coverage.status [ fhir:value "active"] ; fhir:Coverage.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ] ; fhir:Coding.code [ fhir:value "HIP" ] ; fhir:Coding.display [ fhir:value "health insurance plan policy" ] ] ; fhir:CodeableConcept.text [ fhir:value "health insurance plan policy" ] ] ; fhir:Coverage.subscriber [ fhir:link <http://hl7.org/fhir/Patient/Example-Patient1> ; fhir:Reference.reference [ fhir:value "Patient/Example-Patient1" ] ; fhir:Reference.display [ fhir:value "John Doe" ] ] ; fhir:Coverage.subscriberId [ fhir:value "102345672-01"] ; fhir:Coverage.beneficiary [ fhir:link <http://hl7.org/fhir/Patient/Example-Patient2> ; fhir:Reference.reference [ fhir:value "Patient/Example-Patient2" ] ; fhir:Reference.display [ fhir:value "Jane Doe" ] ] ; fhir:Coverage.dependent [ fhir:value "02"] ; fhir:Coverage.relationship [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ; fhir:Coding.code [ fhir:value "spouse" ] ; fhir:Coding.display [ fhir:value "Spouse" ] ] ; fhir:CodeableConcept.text [ fhir:value "Spouse" ] ] ; fhir:Coverage.period [ fhir:Period.start [ fhir:value "2021-01-01"^^xsd:date ] ] ; fhir:Coverage.payor [ fhir:index 0 ; fhir:link <http://hl7.org/fhir/Organization/Example-PayerOrganization1> ; fhir:Reference.reference [ fhir:value "Organization/Example-PayerOrganization1" ] ; fhir:Reference.display [ fhir:value "Acme Insurance Co" ] ] ; fhir:Coverage.class [ fhir:index 0 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ; fhir:Coding.code [ fhir:value "group" ] ] ] ; fhir:Coverage.class.value [ fhir:value "993355" ] ; fhir:Coverage.class.name [ fhir:value "Stars Inc" ] ], [ fhir:index 1 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ; fhir:Coding.code [ fhir:value "plan" ] ] ] ; fhir:Coverage.class.value [ fhir:value "11461128" ] ; fhir:Coverage.class.name [ fhir:value "Acme Gold Plus" ] ], [ fhir:index 2 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS" ] ; fhir:Coding.code [ fhir:value "division" ] ] ] ; fhir:Coverage.class.value [ fhir:value "11" ] ], [ fhir:index 3 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS" ] ; fhir:Coding.code [ fhir:value "network" ] ] ] ; fhir:Coverage.class.value [ fhir:value "561490" ] ; fhir:Coverage.class.name [ fhir:value "Acme Gold Plus South" ] ], [ fhir:index 4 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ; fhir:Coding.code [ fhir:value "rxbin" ] ] ] ; fhir:Coverage.class.value [ fhir:value "100045" ] ], [ fhir:index 5 ; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ] ; fhir:Coding.code [ fhir:value "rxpcn" ] ] ] ; fhir:Coverage.class.value [ fhir:value "1234000" ] ] ; fhir:Coverage.costToBeneficiary [ fhir:index 0 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamOutDed" ] ; fhir:Coding.display [ fhir:value "Family Out of Network Deductible" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 1 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamInDed" ] ; fhir:Coding.display [ fhir:value "Family In Network Deductible" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "8000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 2 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamRxOutDed" ] ; fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Deductible" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "2000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 3 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamRxInDed" ] ; fhir:Coding.display [ fhir:value "Family Pharmacy In Network Deductible" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "1500"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 4 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamOutMax" ] ; fhir:Coding.display [ fhir:value "Family Out of Network Out of Pocket Maximum" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "12000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 5 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamInMax" ] ; fhir:Coding.display [ fhir:value "Family In Network Out of Pocket Maximum" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "10000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 6 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamRxOutMax" ] ; fhir:Coding.display [ fhir:value "Family Pharmacy Out of Network Out of Pocket Maximum" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "3000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ], [ fhir:index 7 ; fhir:Coverage.costToBeneficiary.type [ fhir:CodeableConcept.coding [ fhir:index 0 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS" ] ; fhir:Coding.code [ fhir:value "FamRxInMax" ] ; fhir:Coding.display [ fhir:value "Family Pharmacy In Network Out of Pocket Maximum" ] ] ] ; fhir:Coverage.costToBeneficiary.valueMoney [ fhir:Money.value [ fhir:value "2000"^^xsd:decimal ] ; fhir:Money.currency [ fhir:value "USD" ] ] ] . <http://hl7.org/fhir/InsurancePlan/SBCExampleHMO> a fhir:InsurancePlan . <http://hl7.org/fhir/Patient/Example-Patient1> a fhir:Patient . <http://hl7.org/fhir/Patient/Example-Patient2> a fhir:Patient . <http://hl7.org/fhir/Organization/Example-PayerOrganization1> a fhir:Organization . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/Coverage/Example-Coverage-FSH.ttl> a owl:Ontology ; owl:imports fhir:fhir.ttl ; owl:versionIRI <http://build.fhir.org/Coverage/Example-Coverage-FSH.ttl> .
IG © 2026+ HL7 International / Payer/Provider Information Exchange Work Group. Package hl7.fhir.us.insurance-card#2.0.0-ballot based on FHIR 4.0.1. Generated 2026-08-12
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