{
  "resourceType": "Coverage",
  "id": "SP1234",
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of a Self Pay Agreement.\u003c/div\u003e"
  },
  "identifier": [
    {
      "system": "http://hospitalx.com/selfpayagreement",
      "value": "SP12345678"
    }
  ],
  "status": "active",
  "kind": "self-pay",
  "paymentBy": [
    {
      "party": {
        "reference": "Patient/5"
      }
    }
  ],
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
        "code": "pay",
        "display": "PAY"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/5"
  },
  "beneficiary": {
    "reference": "Patient/5"
  },
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]
  },
  "period": {
    "end": "2012-03-17"
  },
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}