<?xml version="1.0" encoding="UTF-8"?>

<Coverage xmlns="http://hl7.org/fhir">
  <id value="CoverageMatchExample1"/>
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p>Coverage for Robert Johnson - Subscriber ID: 12345678, Previous Health Plan, PPO-GOLD</p></div>
  </text>
  <status value="draft"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="HIP"/>
      <display value="health insurance plan policy"/>
    </coding>
  </type>
  <subscriber>
    <reference value="Patient/patient-prov-001"/>
  </subscriber>
  <subscriberId value="12345678"/>
  <beneficiary>
    <reference value="Patient/patient-prov-001"/>
  </beneficiary>
  <relationship>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
    </coding>
  </relationship>
  <period>
    <start value="2023-01-01"/>
    <end value="2023-12-31"/>
  </period>
  <payor>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9876543210"/>
    </identifier>
    <display value="Previous Health Plan"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="group"/>
      </coding>
    </type>
    <value value="EMPLOY-12345"/>
  </class>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
    </type>
    <value value="PPO-GOLD"/>
  </class>
</Coverage>