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-Coverage1> a fhir:Coverage ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "Example-Coverage1"] ;
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 "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">Acme Gold Plus</div>"
] ;
fhir:DomainResource.extension [
fhir:index 0 ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "memberId" ] ;
fhir:Extension.valueId [ 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.valueId [ 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.valueId [ 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.valueId [ 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-CardIssueDate-extension" ] ;
fhir:Extension.valueDate [ fhir:value "2020-12-15"^^xsd:date ]
], [
fhir:index 6 ;
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 7 ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "label" ] ;
fhir:Extension.valueString [ fhir:value "ACME Inc." ]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "description" ] ;
fhir:Extension.valueString [ fhir:value "Company logo" ]
], [
fhir:index 2 ;
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:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension" ]
], [
fhir:index 8 ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "label" ] ;
fhir:Extension.valueString [ fhir:value "Some lable for this QR code" ]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "description" ] ;
fhir:Extension.valueString [ fhir:value "Usage text for this QR code for the end user" ]
], [
fhir:index 2 ;
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:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension" ]
], [
fhir:index 9 ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "label" ] ;
fhir:Extension.valueString [ fhir:value "Some label for this Barcode" ]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "description" ] ;
fhir:Extension.valueString [ fhir:value "Usage text for this Barcode for the end user" ]
], [
fhir:index 2 ;
fhir:Extension.url [ fhir:value "image" ] ;
fhir:Extension.valueAttachment [
fhir:Attachment.contentType [ fhir:value "image/png" ] ;
fhir:Attachment.data [ fhir:value "iVBORw0KGgoAAAANSUhEUgAAABAAAAAkCAQAAAAqEXJRAAAABGdBTUEAALGPC/xhBQAAACBjSFJNAAB6JgAAgIQAAPoAAACA6AAAdTAAAOpgAAA6mAAAF3CculE8AAAAAmJLR0QA/4ePzL8AAAAHdElNRQflCBoOCChye9NTAAAAsklEQVQ4y+WSsQrCMBCGv9ZCUdwUBEcfR+c+kVPewHdxdxEcBQW1FBTpkFoQ6iJxiSHaRCdB9L/l5+6/kP/uAHpMOKCeYoegDdBlUyveY06zwZghPvQpYe3tVyhmARdi/DhGVvnEVLMRLc1irOcWRpqanAx5g98QRI6WhI6dsAcVkrB82IW0BTmr2rJkgHr5heIzNgsqv+CMYEDutlkh9ARSt81/PpjvONqt4XvDMq6alTdjhHqxFxxRQAAAACV0RVh0ZGF0ZTpjcmVhdGUAMjAyMS0wOC0yNlQxNDowODo0MCswMDowMF+TI3oAAAAldEVYdGRhdGU6bW9kaWZ5ADIwMjEtMDgtMjZUMTQ6MDg6NDArMDA6MDAuzpvGAAAAAElFTkSuQmCC"^^xsd:base64Binary ]
]
] ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension" ]
], [
fhir:index 10 ;
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "label" ] ;
fhir:Extension.valueString [ fhir:value "Some label text" ]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "description" ] ;
fhir:Extension.valueString [ fhir:value "Some text for the end user about the usage/meaning of this image" ]
], [
fhir:index 2 ;
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: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 "10000.00"^^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 "8000.00"^^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 "2000.00"^^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 "1500.00"^^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 "12000.00"^^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 "10000.00"^^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 "3000.00"^^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 "2000.00"^^xsd:decimal ] ;
fhir:Money.currency [ fhir:value "USD" ]
]
], [
fhir:index 8 ;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ] ;
fhir:Coding.code [ fhir:value "gpvisit" ]
]
] ;
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ] ;
fhir:Extension.valueString [ fhir:value "N/A" ]
]
]
], [
fhir:index 9 ;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ] ;
fhir:Coding.code [ fhir:value "spvisit" ]
]
] ;
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ] ;
fhir:Extension.valueString [ fhir:value "N/A" ]
]
]
], [
fhir:index 10 ;
fhir:Coverage.costToBeneficiary.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-copay-type" ] ;
fhir:Coding.code [ fhir:value "emergency" ]
]
] ;
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ] ;
fhir:Extension.valueString [ fhir:value "N/A" ]
]
]
], [
fhir:index 11 ;
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 "rx" ]
]
] ;
fhir:Coverage.costToBeneficiary.valueMoney [
fhir:Element.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension" ] ;
fhir:Extension.valueString [ fhir:value "DED THEN $10/$40/$70/25%" ]
]
]
] .
<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-Coverage1.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/Coverage/Example-Coverage1.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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