{
  "resourceType" : "Coverage",
  "id" : "Coverage1",
  "meta" : {
    "lastUpdated" : "2020-10-30T09:48:01.8462752-04:00",
    "profile" : ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.2.0"]
  },
  "language" : "en",
  "text" : {
    "status" : "generated"
  },
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "version" : "5.0.0",
        "code" : "MB",
        "display" : "Member Number"
      }],
      "text" : "An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier."
    },
    "system" : "https://www.example.com/fhir/memberidentifier",
    "value" : "88800933501",
    "assigner" : {
      "reference" : "Organization/Payer2",
      "display" : "UPMC Health Plan"
    }
  }],
  "status" : "active",
  "policyHolder" : {
    "reference" : "Patient/Patient1"
  },
  "subscriber" : {
    "reference" : "Patient/Patient1"
  },
  "subscriberId" : "888009335",
  "beneficiary" : {
    "reference" : "Patient/Patient1"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "self"
    }],
    "text" : "Self"
  },
  "period" : {
    "start" : "2020-01-01"
  },
  "payor" : [{
    "reference" : "Organization/Payer2",
    "display" : "UPMC Health Plan"
  }],
  "class" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "group",
        "display" : "Group"
      }],
      "text" : "An employee group"
    },
    "value" : "MCHMO1",
    "name" : "MEDICARE HMO PLAN"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "plan",
        "display" : "Plan"
      }],
      "text" : "A specific suite of benefits."
    },
    "value" : "GR5",
    "name" : "GR5-HMO DEDUCTIBLE"
  }],
  "network" : "GR5-HMO DEDUCTIBLE"
}