@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/us/insurance-card/Coverage/Example-Coverage1> a fhir:Coverage ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "Example-Coverage1"] ; # 
  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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage>
     ] )
  ] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">Acme Gold Plus</div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "memberId"^^xsd:anyURI ;
         fhir:l fhir:memberId
       ] ;
       fhir:value [
         a fhir:Id ;
         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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "memberId"^^xsd:anyURI ;
         fhir:l fhir:memberId
       ] ;
       fhir:value [
         a fhir:Id ;
         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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "memberId"^^xsd:anyURI ;
         fhir:l fhir:memberId
       ] ;
       fhir:value [
         a fhir:Id ;
         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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "memberId"^^xsd:anyURI ;
         fhir:l fhir:memberId
       ] ;
       fhir:value [
         a fhir:Id ;
         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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension>
     ]
  ] [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension>
     ] ;
     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-CardIssueDate-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension>
     ] ;
     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 <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/IECColourManagement>
           ] ;
           fhir:code [ fhir:v "#00bfff" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/IECColourManagement>
           ] ;
           fhir:code [ fhir:v "#000000" ]
         ] )
       ]
     ] [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/IECColourManagement"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/IECColourManagement>
           ] ;
           fhir:code [ fhir:v "#ceebf5" ]
         ] )
       ]
     ] ) ;
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ColorPalette-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "label"^^xsd:anyURI ;
         fhir:l fhir:label
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "ACME Inc."
       ]
     ] [
       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 "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "label"^^xsd:anyURI ;
         fhir:l fhir:label
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "Some lable for this QR code"
       ]
     ] [
       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 "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension>
     ]
  ] [
     fhir:extension ( [
       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 "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 "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension>
     ]
  ] [
     fhir:extension ( [
       fhir:url [
         fhir:v "label"^^xsd:anyURI ;
         fhir:l fhir:label
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "Some label text"
       ]
     ] [
       fhir:url [
         fhir:v "description"^^xsd:anyURI ;
         fhir:l fhir:description
       ] ;
       fhir:value [
         a fhir:String ;
         fhir:v "Some text for the end user about the usage/meaning of this image"
       ]
     ] [
       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 "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension>
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
         ] ;
         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 <https://www.acmeinsurance.com/glossary/memberid>
     ] ;
     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 <http://terminology.hl7.org/CodeSystem/v3-ActCode>
       ] ;
       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 <http://hl7.org/fhir/us/insurance-card/Patient/Example-Patient1> ;
     fhir:reference [ fhir:v "Patient/Example-Patient1" ] ;
     fhir:display [ fhir:v "John Doe" ]
  ] ; # 
  fhir:subscriberId [ fhir:v "102345672-01"] ; # 
  fhir:beneficiary [
     fhir:l <http://hl7.org/fhir/us/insurance-card/Patient/Example-Patient2> ;
     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 <http://terminology.hl7.org/CodeSystem/subscriber-relationship>
       ] ;
       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 <http://hl7.org/fhir/us/insurance-card/Organization/Example-PayerOrganization1> ;
     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 <http://terminology.hl7.org/CodeSystem/coverage-class>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/coverage-class>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/C4DICExtendedCoverageClassCS>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/coverage-class>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/coverage-class>
         ] ;
         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 <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         fhir:code [ fhir:v "FamOutDed" ] ;
         fhir:display [ fhir:v "Family Out of Network Deductible" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:value [ fhir:v 10000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         fhir:code [ fhir:v "FamInDed" ] ;
         fhir:display [ fhir:v "Family In Network Deductible" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:value [ fhir:v 8000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         fhir:code [ fhir:v "FamRxOutDed" ] ;
         fhir:display [ fhir:v "Family Pharmacy Out of Network Deductible" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:value [ fhir:v 2000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         fhir:code [ fhir:v "FamRxInDed" ] ;
         fhir:display [ fhir:v "Family Pharmacy In Network Deductible" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:value [ fhir:v 1500.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         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 12000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         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 10000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         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 3000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         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 2000.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/coverage-copay-type>
         ] ;
         fhir:code [ fhir:v "gpvisit" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension>
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "N/A"
         ]
       ] )
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/coverage-copay-type>
         ] ;
         fhir:code [ fhir:v "spvisit" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension>
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "N/A"
         ]
       ] )
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/coverage-copay-type"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/coverage-copay-type>
         ] ;
         fhir:code [ fhir:v "emergency" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension>
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "N/A"
         ]
       ] )
     ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS>
         ] ;
         fhir:code [ fhir:v "rx" ]
       ] )
     ] ;
     fhir:value [
       a fhir:Money ;
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension>
         ] ;
         fhir:value [
           a fhir:String ;
           fhir:v "DED THEN $10/$40/$70/25%"
         ]
       ] )
     ]
  ] ) . # 

<http://hl7.org/fhir/us/insurance-card/Patient/Example-Patient1> a fhir:Us .

<http://hl7.org/fhir/us/insurance-card/Patient/Example-Patient2> a fhir:Us .

<http://hl7.org/fhir/us/insurance-card/Organization/Example-PayerOrganization1> a fhir:Us .

# -------------------------------------------------------------------------------------