US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

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: Coverage example

Page standards status: Informative

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{
  "resourceType" : "Coverage",
  "id" : "example",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-coverage"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-us-quality-core-coverage.html\">US Quality Core Coverage</a></p></div><p><b>identifier</b>: Member ID/MB123456789</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:\">Preferred Provider Organization (PPO)</span></p><p><b>policyHolder</b>: <a href=\"Patient-example.html\">Example Patient  Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriber</b>: <a href=\"Patient-example.html\">Example Patient  Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --&gt; (ongoing)))</a></p><p><b>subscriberId</b>: SUB987654321</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Example Patient  Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --&gt; (ongoing)))</a></p><p><b>dependent</b>: 0</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2026-01-01 --&gt; 2026-12-31</p><p><b>payor</b>: <a href=\"Organization-example.html\">Organization Example Organization</a></p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class group}\">Group</span></p><p><b>value</b>: GRP-99482</p><p><b>name</b>: Example Employer Health Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class plan}\">Plan</span></p><p><b>value</b>: PLN-GOLD-2026</p><p><b>name</b>: Example PPO Option</p></blockquote></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB",
            "display" : "Member Number"
          }
        ],
        "text" : "Member ID"
      },
      "system" : "http://example.org/payer/member-ids",
      "value" : "MB123456789"
    }
  ],
  "status" : "active",
  "type" : {
    "text" : "Preferred Provider Organization (PPO)"
  },
  "policyHolder" : {
    🔗 "reference" : "Patient/example"
  },
  "subscriber" : {
    🔗 "reference" : "Patient/example"
  },
  "subscriberId" : "SUB987654321",
  "beneficiary" : {
    🔗 "reference" : "Patient/example"
  },
  "dependent" : "0",
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2026-01-01",
    "end" : "2026-12-31"
  },
  "payor" : [
    {
      🔗 "reference" : "Organization/example"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group",
            "display" : "Group"
          }
        ]
      },
      "value" : "GRP-99482",
      "name" : "Example Employer Health Plan"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "plan",
            "display" : "Plan"
          }
        ]
      },
      "value" : "PLN-GOLD-2026",
      "name" : "Example PPO Option"
    }
  ]
}