{
  "resourceType" : "Coverage",
  "id" : "Coverage3",
  "meta" : {
    "lastUpdated" : "2020-07-07T13:26:22.0314215+00:00",
    "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"
      }]
    },
    "system" : "https://www.example.com/fhir/memberidentifier",
    "value" : "1234-234-1243-12345678901"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code" : "HIP"
    }],
    "text" : "health insurance plan policy"
  },
  "policyHolder" : {
    "reference" : "Patient/Patient2"
  },
  "subscriber" : {
    "reference" : "Patient/Patient2"
  },
  "subscriberId" : "12345678901",
  "beneficiary" : {
    "reference" : "Patient/Patient2"
  },
  "dependent" : "01",
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "self"
    }]
  },
  "period" : {
    "start" : "2019-01-01",
    "end" : "2019-10-31"
  },
  "payor" : [{
    "reference" : "Organization/Payer1"
  }],
  "class" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "group"
      }],
      "text" : "An employee group"
    },
    "value" : "021890",
    "name" : "Acme Corporation"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "plan"
      }],
      "text" : "Plan"
    },
    "value" : "XYZ123",
    "name" : "XYZ123-UPMC CONSUMER ADVA"
  }],
  "network" : "XYZ123-UPMC CONSUMER ADVA"
}