# CoverageExample - Da Vinci - Documentation Templates and Rules v2.2.0

## Example Coverage: CoverageExample



## Resource Content

```json
{
  "resourceType" : "Coverage",
  "id" : "CoverageExample",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"]
  },
  "language" : "en",
  "contained" : [{
    "resourceType" : "Organization",
    "id" : "OrgExample",
    "meta" : {
      "profile" : ["http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"]
    },
    "identifier" : [{
      "system" : "urn:oid:2.16.840.1.113883.4.7",
      "value" : "10D0202020"
    }],
    "active" : true,
    "type" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
        "code" : "pay",
        "display" : "Payer"
      }]
    }],
    "name" : "Insurance Company",
    "telecom" : [{
      "system" : "phone",
      "value" : "860-547-5001",
      "use" : "work"
    }],
    "address" : [{
      "line" : ["680 Asylum Street"],
      "city" : "Hartford",
      "state" : "CT",
      "postalCode" : "06155",
      "country" : "US"
    }]
  }],
  "status" : "active",
  "subscriber" : {
    "reference" : "Patient/examplepatient"
  },
  "subscriberId" : "PFP123450000",
  "beneficiary" : {
    "reference" : "Patient/examplepatient"
  },
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "self",
      "display" : "Self"
    }]
  },
  "period" : {
    "start" : "2022-01-01",
    "end" : "2023-01-01"
  },
  "payor" : [{
    "reference" : "#OrgExample"
  }],
  "class" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
        "code" : "plan",
        "display" : "Plan"
      }]
    },
    "value" : "Premim Family Plus",
    "name" : "Premim Family Plus Plan"
  }]
}

```
