@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Coverage ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "Example-Coverage-FSH"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; fhir:lastUpdated [ fhir:v "2021-04-06T10:49:02.473+00:00"^^xsd:dateTime ] ; fhir:profile ( [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage"^^xsd:anyURI ; fhir:l ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "

Generated Narrative: Coverage Example-Coverage-FSH

version: 1; Last updated: 2021-04-06 10:49:02+0000

Profile: C4DIC Coverage

Plan Beneficiaries

  • memberId: 102345672-01
  • name: John Doe

Plan Beneficiaries

  • memberId: 102345672-02
  • name: jane Doe

Plan Beneficiaries

  • memberId: 102345672-03
  • name: Jimmy Doe

Plan Beneficiaries

  • memberId: 102345672-04
  • name: Ginny Doe

Additional Insurance Card Information:

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.

\n

Additional Insurance Card Information: Summary of Benefits and Coverage - Acme Gold Plus HMO

Card Issue Date: 2020-12-15

Color Palette

  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension: #00bfff
  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension: #000000
  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension: #ceebf5

Logo

  • description: Company logo
  • image: image/png: 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
  • label: ACME Inc.

QR Code

  • description: Usage text for this QR code for the end user
  • image: image/png: 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
  • label: Some label for this QR code

Barcode

  • description: Usage text for this Barcode for the end user
  • image: image/png: 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
  • label: Some label for this Barcode

Supporting image

  • description: Image of the front of the member's physical insurance card showing plan name, member ID, and group number
  • image: image/jpeg: 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
  • label: Front of insurance card

Supporting image

  • description: Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information
  • image: image/jpeg: 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
  • label: Back of insurance card

identifier: Member Number/102345672-02

status: Active

type: health insurance plan policy

subscriber: John Doe

subscriberId: 102345672-01

beneficiary: Jane Doe

dependent: 02

relationship: Spouse

period: 2021-01-01 --> (ongoing)

payor: Acme Insurance Co

class

type: Group

value: 993355

name: Stars Inc

class

type: Plan

value: 11461128

name: Acme Gold Plus

class

type: Division

value: 11

class

type: Network

value: 561490

name: Acme Gold Plus South

class

type: RX BIN

value: 100045

class

type: RX PCN

value: 1234000

costToBeneficiary

type: Family Out of Network Deductible

value: $10,000.00 (USD)

costToBeneficiary

type: Family In Network Deductible

value: $8,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Deductible

value: $2,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Deductible

value: $1,500.00 (USD)

costToBeneficiary

type: Family Out of Network Out of Pocket Maximum

value: $12,000.00 (USD)

costToBeneficiary

type: Family In Network Out of Pocket Maximum

value: $10,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Out of Pocket Maximum

value: $3,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Out of Pocket Maximum

value: $2,000.00 (USD)

"^^rdf:XMLLiteral ] ] ; # fhir:extension ( [ fhir:extension ( [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ; fhir:l fhir:memberId ] ; fhir:value [ a fhir:String ; fhir:v "102345672-01" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ; fhir:l fhir:name ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; fhir:given ( [ fhir:v "John" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ; fhir:l fhir:memberId ] ; fhir:value [ a fhir:String ; fhir:v "102345672-02" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ; fhir:l fhir:name ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; fhir:given ( [ fhir:v "jane" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ; fhir:l fhir:memberId ] ; fhir:value [ a fhir:String ; fhir:v "102345672-03" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ; fhir:l fhir:name ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; fhir:given ( [ fhir:v "Jimmy" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "memberId"^^xsd:anyURI ; fhir:l fhir:memberId ] ; fhir:value [ a fhir:String ; fhir:v "102345672-04" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ; fhir:l fhir:name ] ; fhir:value [ a fhir:HumanName ; fhir:family [ fhir:v "Doe" ] ; fhir:given ( [ fhir:v "Ginny" ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Annotation ; fhir:text [ fhir:v "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:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Reference ; fhir:l ; fhir:reference [ fhir:v "InsurancePlan/SBCExampleHMO" ] ; fhir:display [ fhir:v "Summary of Benefits and Coverage - Acme Gold Plus HMO" ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:Date ; fhir:v "2020-12-15"^^xsd:date ] ] [ fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "#00bfff" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "#000000" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension"^^xsd:anyURI ; fhir:l ] ; fhir:value [ a fhir:CodeableConcept ; fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "#ceebf5" ] ] ) ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "description"^^xsd:anyURI ; fhir:l fhir:description ] ; fhir:value [ a fhir:String ; fhir:v "Company logo" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ; fhir:l fhir:image ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ; fhir:l fhir:label ] ; fhir:value [ a fhir:String ; fhir:v "ACME Inc." ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "description"^^xsd:anyURI ; fhir:l fhir:description ] ; fhir:value [ a fhir:String ; fhir:v "Usage text for this QR code for the end user" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ; fhir:l fhir:image ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ; fhir:l fhir:label ] ; fhir:value [ a fhir:String ; fhir:v "Some label for this QR code" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "description"^^xsd:anyURI ; fhir:l fhir:description ] ; fhir:value [ a fhir:String ; fhir:v "Usage text for this Barcode for the end user" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ; fhir:l fhir:image ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/png" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ; fhir:l fhir:label ] ; fhir:value [ a fhir:String ; fhir:v "Some label for this Barcode" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "description"^^xsd:anyURI ; fhir:l fhir:description ] ; fhir:value [ a fhir:String ; fhir:v "Image of the front of the member's physical insurance card showing plan name, member ID, and group number" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ; fhir:l fhir:image ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/jpeg" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ; fhir:l fhir:label ] ; fhir:value [ a fhir:String ; fhir:v "Front of insurance card" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"^^xsd:anyURI ; fhir:l ] ] [ fhir:extension ( [ fhir:url [ fhir:v "description"^^xsd:anyURI ; fhir:l fhir:description ] ; fhir:value [ a fhir:String ; fhir:v "Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information" ] ] [ fhir:url [ fhir:v "image"^^xsd:anyURI ; fhir:l fhir:image ] ; fhir:value [ a fhir:Attachment ; fhir:contentType [ fhir:v "image/jpeg" ] ; fhir:data [ fhir:v "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"^^xsd:base64Binary ] ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ; fhir:l fhir:label ] ; fhir:value [ a fhir:String ; fhir:v "Back of insurance card" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"^^xsd:anyURI ; fhir:l ] ] ) ; # fhir:identifier ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "MB" ] ; fhir:display [ fhir:v "Member Number" ] ] ) ] ; fhir:system [ fhir:v "https://www.acmeinsurance.com/glossary/memberid"^^xsd:anyURI ; fhir:l ] ; fhir:value [ fhir:v "102345672-02" ] ; fhir:assigner [ fhir:display [ fhir:v "Acme Insurance Co" ] ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "HIP" ] ; fhir:display [ fhir:v "health insurance plan policy" ] ] ) ; fhir:text [ fhir:v "health insurance plan policy" ] ] ; # fhir:subscriber [ fhir:l ; fhir:reference [ fhir:v "Patient/Example-Patient1" ] ; fhir:display [ fhir:v "John Doe" ] ] ; # fhir:subscriberId [ fhir:v "102345672-01"] ; # fhir:beneficiary [ fhir:l ; fhir:reference [ fhir:v "Patient/Example-Patient2" ] ; fhir:display [ fhir:v "Jane Doe" ] ] ; # fhir:dependent [ fhir:v "02"] ; # fhir:relationship [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "spouse" ] ; fhir:display [ fhir:v "Spouse" ] ] ) ; fhir:text [ fhir:v "Spouse" ] ] ; # fhir:period [ fhir:start [ fhir:v "2021-01-01"^^xsd:date ] ] ; # fhir:payor ( [ fhir:l ; fhir:reference [ fhir:v "Organization/Example-PayerOrganization1" ] ; fhir:display [ fhir:v "Acme Insurance Co" ] ] ) ; # fhir:class ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "group" ] ] ) ] ; fhir:value [ fhir:v "993355" ] ; fhir:name [ fhir:v "Stars Inc" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "plan" ] ] ) ] ; fhir:value [ fhir:v "11461128" ] ; fhir:name [ fhir:v "Acme Gold Plus" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "division" ] ] ) ] ; fhir:value [ fhir:v "11" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "network" ] ] ) ] ; fhir:value [ fhir:v "561490" ] ; fhir:name [ fhir:v "Acme Gold Plus South" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "rxbin" ] ] ) ] ; fhir:value [ fhir:v "100045" ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "rxpcn" ] ] ) ] ; fhir:value [ fhir:v "1234000" ] ] ) ; # fhir:costToBeneficiary ( [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamOutDed" ] ; fhir:display [ fhir:v "Family Out of Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamInDed" ] ; fhir:display [ fhir:v "Family In Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "8000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamRxOutDed" ] ; fhir:display [ fhir:v "Family Pharmacy Out of Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamRxInDed" ] ; fhir:display [ fhir:v "Family Pharmacy In Network Deductible" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "1500"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamOutMax" ] ; fhir:display [ fhir:v "Family Out of Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "12000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamInMax" ] ; fhir:display [ fhir:v "Family In Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "10000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamRxOutMax" ] ; fhir:display [ fhir:v "Family Pharmacy Out of Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "3000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] [ fhir:type [ fhir:coding ( [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "FamRxInMax" ] ; fhir:display [ fhir:v "Family Pharmacy In Network Out of Pocket Maximum" ] ] ) ] ; fhir:value [ a fhir:Money ; fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:currency [ fhir:v "USD" ] ] ] ) . # a fhir:Us . a fhir:Us . a fhir:Us . a fhir:Us . # -------------------------------------------------------------------------------------