# Coverage example - Da Vinci - Coverage Requirements Discovery v2.2.0-snapshot

## Example Coverage: Coverage example

Language: en

**identifier**: Member Number/12345

**status**: Active

**type**: extended healthcare

**policyHolder**: [http://example.org/FHIR/Organization/CBI35](http://example.org/FHIR/Organization/CBI35)

**subscriber**: [Amy V. Shaw Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))](Patient-example.md)

**beneficiary**: [Amy V. Shaw Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))](Patient-example.md)

**dependent**: 0

**relationship**: Self

**period**: 2011-05-23 --> 2012-05-23

**payor**: [Payer XYZ](http://example.org/fhir/Organization/example-payer)

### Classes

| | | | |
| :--- | :--- | :--- | :--- |
| - | **Type** | **Value** | **Name** |
| * | Group | CB135 | Corporate Baker's Inc. Local #35 |



## Resource Content

```json
{
  "resourceType" : "Coverage",
  "id" : "example",
  "language" : "en",
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "http://example.org/fhir/NampingSystem/certificate",
      "value" : "12345"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL",
        "display" : "extended healthcare"
      }
    ]
  },
  "policyHolder" : {
    "reference" : "http://example.org/FHIR/Organization/CBI35"
  },
  "subscriber" : {
    "reference" : "Patient/example"
  },
  "beneficiary" : {
    "reference" : "Patient/example"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      }
    ]
  },
  "period" : {
    "start" : "2011-05-23",
    "end" : "2012-05-23"
  },
  "payor" : [
    {
      "reference" : "http://example.org/fhir/Organization/example-payer",
      "display" : "Payer XYZ"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "version" : "1.0.1",
            "code" : "group"
          }
        ]
      },
      "value" : "CB135",
      "name" : "Corporate Baker's Inc. Local #35"
    }
  ]
}

```
