# Coverage - Blue Cross Blue Shield HMO - Health Care Surveys Reporting v2.0.0

## Example Coverage: Coverage - Blue Cross Blue Shield HMO

Language: en

Profile: [US Core Coverage Profileversion: null6.1.0)](http://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-coverage.html)

**status**: Active

**policyHolder**: [Dominique Ledner Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))](Patient-patient-ledner.md)

**subscriber**: [Dominique Ledner Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))](Patient-patient-ledner.md)

**subscriberId**: XYZ123456789

**beneficiary**: [Dominique Ledner Female, DoB: 1965-06-22 ( MRN: Alaska Driver's License#abc123 (use: usual, ))](Patient-patient-ledner.md)

**dependent**: 0

**relationship**: Self

**period**: 2025-01-01 --> 2025-12-31

**payor**: [Organization Blue Cross Blue Shield](Organization-organization-payer-bcbs.md)

> **class****type**: Group**value**: ABC987**name**: Group Name

> **class****type**: Plan**value**: HMO**name**: Health Maintenance Organization



## Resource Content

```json
{
  "resourceType" : "Coverage",
  "id" : "coverage-bcbs-example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|6.1.0"
    ]
  },
  "language" : "en",
  "status" : "active",
  "policyHolder" : {
    "reference" : "Patient/patient-ledner"
  },
  "subscriber" : {
    "reference" : "Patient/patient-ledner"
  },
  "subscriberId" : "XYZ123456789",
  "beneficiary" : {
    "reference" : "Patient/patient-ledner"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2025-01-01",
    "end" : "2025-12-31"
  },
  "payor" : [
    {
      "reference" : "Organization/organization-payer-bcbs"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group",
            "display" : "Group"
          }
        ]
      },
      "value" : "ABC987",
      "name" : "Group Name"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ]
      },
      "value" : "HMO",
      "name" : "Health Maintenance Organization"
    }
  ]
}

```
