LinuxForHealth FHIR Implementation Guide
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LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions

: Coverage Example - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "CoverageExample",
  "meta" : {
    "extension" : [
      {
        "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/source-file-id",
        "valueString" : "e00085555"
      }
    ],
    "source" : "http://acme-health.com/WellnessInsuranceCompany",
    "profile" : [
      "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cdm-coverage"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"CoverageExample\"> </a></p><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\">Resource Coverage \"CoverageExample\" </p><p style=\"margin-bottom: 0px\">Information Source: http://acme-health.com/WellnessInsuranceCompany!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdm-coverage.html\">CDM Coverage</a></p></div><p><b>SubscriberId Encrypted</b>: p58299i3-3t5z-2hyg-7256-g2un4f887e08</p><p><b>Age and Gender Groups</b>: Males 20-24 yr <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-age-gender-group.html\">Age and Gender Group Codes</a>#7)</span></p><p><b>Snapshot Age In Years</b>: 21</p><p><b>Employee Age In Years</b>: 21</p><p><b>Benefit Status</b>: Active <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hipaa-benefit-status.html\">HIPAA Benefit Status Codes</a>#A)</span></p><p><b>Cobra Indicator</b>: N</p><p><b>Coverage Month</b>: 2000-06-01</p><p><b>Dual Eligibility Indicator</b>: N</p><p><b>Employee Average Scheduled Hours</b>: 35.5</p><p><b>Employee Birth Date</b>: 1990</p><p><b>Employee Business Unit</b>: EmpBusUnit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-business-unit#EmpBusUnit)</span></p><p><b>Employee Company</b>: LocalEmpCompany <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-company#LocalEmpCompany)</span></p><p><b>Employee Cost Center</b>: LocalEmpCostCenter <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-cost-center#LocalEmpCostCenter)</span></p><p><b>Employee Department</b>: LocalEmpDepartment <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-department#LocalEmpDepartment)</span></p><p><b>Employee Division</b>: LocalEmpDivision <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-division#LocalEmpDivision)</span></p><p><b>Employee Education Level</b>: Some College <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-education-level.html\">Payer Education Level Codes</a>#D; local-employee-education-level#AttendedCollege)</span></p><p><b>Employee Exempt Indicator</b>: N</p><p><b>Employee Family Size</b>: 2</p><p><b>Employee Gender</b>: Male <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-gender.html\">Payer Gender Codes</a>#M)</span></p><p><b>Employee Hire Date</b>: 2000-01-01</p><p><b>Employee Id</b>: id: 555555</p><p><b>Employee Job Family</b>: LocalEmpJobFamilyCd <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-job-family#LocalEmpJobFamilyCd)</span></p><p><b>Employee Job Grade</b>: LocalEmpJobGradeCd <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-job-grade#LocalEmpJobGradeCd)</span></p><p><b>Employee Job Location</b>: EmpJobLocationCd <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-physical-job-location#EmpJobLocationCd; local-geographic-job-location#CardingtonOhio)</span></p><p><b>Employee Job Title</b>: SoftwareEngineer <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-job-title#SoftwareEngineer; unknown#15-1131)</span></p><p><b>Employee Labor Union</b>: LocalTeams377 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-labor-union#LocalTeams377)</span></p><p><b>Employee Pay Frequency</b>: Monthly <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-pay-frequency#Monthly)</span></p><p><b>Employee Performance Rating</b>: Meets <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-performance-rating#Meets)</span></p><p><b>Employee Retirement Date</b>: 2099-12-31</p><p><b>Employee Shift</b>: Day <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-shift#Day)</span></p><p><b>Employee Status</b>: LocalEmpStatus <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-status#LocalEmpStatus; <a href=\"CodeSystem-payer-employee-status-code.html\">payer Employee Status Codes</a>#1; <a href=\"CodeSystem-hipaa-employee-status.html\">HIPAA Employee Status Codes</a>#AC)</span></p><p><b>Employee Sub Business Unit</b>: LocalEmpSubBusinessUnit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-sub-business-unit#LocalEmpSubBusinessUnit)</span></p><p><b>Employee Termination Date</b>: 2099-12-31</p><p><b>Employee Termination Reason</b>: NotTermed <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-termination-reason#NotTermed)</span></p><p><b>Employee Wage Amount</b>: 46500</p><p><b>Employee Wage Basis</b>: Annual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employee-wage-basis#Annual)</span></p><p><b>Employee Year Of Service</b>: 1</p><p><b>Employee Union Id</b>: MemberUnionId-407</p><p><b>Enrollment PCP Name On Enrollment</b>: Dr Kelly</p><p><b>Enrollment PCP Zip On Enrollment</b>: 75014</p><p><b>Enrollment PCP</b>: EnrollmentPCP1</p><p><b>Employer</b>: LocalEmployerCode <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-employer#LocalEmployerCode)</span></p><p><b>Family Income Level</b>: 26500 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-income-level#26500)</span></p><p><b>Job Class Code</b>: jobclass <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-job-class-code#jobclass)</span></p><p><b>Job Location Zipcode</b>: 43315</p><p><b>Long Term Disability Benefit Rate</b>: 10</p><p><b>Medicare Coverage</b>: Not Eligible for Medicare <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-medicare-coverage.html\">Payer Medicare Coverage Codes</a>#N)</span></p><p><b>Medicare Indicator</b>: N</p><p><b>Member Employee Indicator</b>: MemberEmployee <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-member-employee-indicator#MemberEmployee)</span></p><p><b>Restricted Benefits</b>: LocalRestrictedBenefits <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (local-restricted-benefits#LocalRestrictedBenefits)</span></p><p><b>Salary Indicator</b>: Y</p><p><b>Short Term Disability Benefit Rate</b>: 30</p><p><b>SSI Indicator</b>: N</p><p><b>SSI Status</b>: Unknown <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-ssi-status.html\">Payer SSI Status Codes</a>#999)</span></p><p><b>TANF Benefits</b>: TANF status is unknown <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-tanf-benefit.html\">Payer TANF Benefit codes</a>#9)</span></p><p><b>Total Dependent Count</b>: 1</p><p><b>Union Worker Indicator</b>: N</p><p><b>identifier</b>: Source System Row Identifier: c35466d6-0d2b-4efa-8265-b9ac3f887e08(use: OFFICIAL)</p><p><b>status</b>: active</p><p><b>subscriberId</b>: FamilyId_0001</p><p><b>beneficiary</b>: <a href=\"Patient-CDMPatientInstance.html\">Patient/CDMPatientInstance</a> \" MCLASTNAME\"</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self; local-subscriber-relationship#LocalRelationship; <a href=\"CodeSystem-hipaa-relationship.html\">HIPAA Relationship Codes</a>#18)</span></p><p><b>period</b>: 2000-01-01 --&gt; 2000-10-31</p><p><b>payor</b>: <span></span></p><blockquote><p><b>class</b></p><p><b>type</b>: Election Tier <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#election-tier)</span></p><p><b>value</b>: Family</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Election Tier <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#election-tier)</span></p><p><b>value</b>: dental employee only</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Election Tier <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#election-tier)</span></p><p><b>value</b>: vision employee only</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Group Type <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-payer-coverage-class.html\">Payer Coverage Class Codes</a>#group-type)</span></p><p><b>value</b>: HMO</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: Group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/4.0.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group)</span></p><p><b>value</b>: GR12345</p></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/subscriberId-encrypted",
      "valueString" : "p58299i3-3t5z-2hyg-7256-g2un4f887e08"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/age-gender-group",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/age-gender-group",
            "code" : "7"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/snapshot-age-in-years",
      "valueUnsignedInt" : 21
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-snapshot-age-in-years",
      "valueUnsignedInt" : 21
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/benefit-status",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/hipaa-benefit-status",
            "code" : "A"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/cobra-indicator",
      "valueString" : "N"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/coverage-month",
      "valueDate" : "2000-06-01"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/dual-eligibility-indicator",
      "valueString" : "N"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-average-scheduled-hours",
      "valueDecimal" : 35.5
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-birth-date",
      "valueDate" : "1990"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-business-unit",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-business-unit",
            "code" : "EmpBusUnit"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-company",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-company",
            "code" : "LocalEmpCompany"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-cost-center",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-cost-center",
            "code" : "LocalEmpCostCenter"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-department",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-department",
            "code" : "LocalEmpDepartment"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-division",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-division",
            "code" : "LocalEmpDivision"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-education-level",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-education-level",
            "code" : "D"
          },
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-education-level",
            "code" : "AttendedCollege"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-exempt-indicator",
      "valueString" : "N"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-family-size",
      "valueInteger" : 2
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-gender",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-gender",
            "code" : "M"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-hire-date",
      "valueDate" : "2000-01-01"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-id",
      "valueIdentifier" : {
        "value" : "555555"
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-family",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-job-family",
            "code" : "LocalEmpJobFamilyCd"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-grade",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-job-grade",
            "code" : "LocalEmpJobGradeCd"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-location",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-physical-job-location",
            "code" : "EmpJobLocationCd"
          },
          {
            "system" : "http://acme-health.com/CodeSystem/local-geographic-job-location",
            "code" : "CardingtonOhio"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-job-title",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-job-title",
            "code" : "SoftwareEngineer"
          },
          {
            "system" : "urn:oid:2.16.840.1.113883.6.243",
            "code" : "15-1131"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-labor-union",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-labor-union",
            "code" : "LocalTeams377"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-pay-frequency",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-pay-frequency",
            "code" : "Monthly"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-performance-rating",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-performance-rating",
            "code" : "Meets"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-retirement-date",
      "valueDate" : "2099-12-31"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-shift",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-shift",
            "code" : "Day"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-status",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-status",
            "code" : "LocalEmpStatus"
          },
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-employee-status-code",
            "code" : "1"
          },
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/hipaa-employee-status",
            "code" : "AC"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-sub-business-unit",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-sub-business-unit",
            "code" : "LocalEmpSubBusinessUnit"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-date",
      "valueDate" : "2099-12-31"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-termination-reason",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-termination-reason",
            "code" : "NotTermed"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-amount",
      "valueDecimal" : 46500
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-wage-basis",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employee-wage-basis",
            "code" : "Annual"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-year-of-service",
      "valueUnsignedInt" : 1
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employee-union-id",
      "valueString" : "MemberUnionId-407"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-name-on-enrollment",
      "valueString" : "Dr Kelly"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp-zip-on-enrollment",
      "valueString" : "75014"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/enrollment-pcp",
      "valueString" : "EnrollmentPCP1"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/employer",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-employer",
            "code" : "LocalEmployerCode"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/family-income-level",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-income-level",
            "code" : "26500"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-class-code",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-job-class-code",
            "code" : "jobclass"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/job-location-zipcode",
      "valueString" : "43315"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/long-term-disability-benefit-rate",
      "valueDecimal" : 10
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-coverage",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-medicare-coverage",
            "code" : "N"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/medicare-indicator",
      "valueString" : "N"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/member-employee-indicator",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-member-employee-indicator",
            "code" : "MemberEmployee"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/restricted-benefits",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://acme-health.com/CodeSystem/local-restricted-benefits",
            "code" : "LocalRestrictedBenefits"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/salary-indicator",
      "valueString" : "Y"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/short-term-disability-benefit-rate",
      "valueDecimal" : 30
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-indicator",
      "valueString" : "N"
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/ssi-status",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-ssi-status",
            "code" : "999"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/tanf-benefits",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-tanf-benefit",
            "code" : "9"
          }
        ]
      }
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/total-dependent-count",
      "valueInteger" : 1
    },
    {
      "url" : "http://linuxforhealth.org/fhir/cdm/StructureDefinition/union-worker-indicator",
      "valueString" : "N"
    }
  ],
  "identifier" : [
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/identifier-type",
            "code" : "SSRI"
          }
        ]
      },
      "system" : "http://acme-health.com/emr1/coverage",
      "value" : "c35466d6-0d2b-4efa-8265-b9ac3f887e08",
      "assigner" : {
        "display" : "Acme Health - EMR1"
      }
    }
  ],
  "status" : "active",
  "subscriberId" : "FamilyId_0001",
  "beneficiary" : {
    "reference" : "Patient/CDMPatientInstance"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self"
      },
      {
        "system" : "http://acme-health.com/CodeSystem/local-subscriber-relationship",
        "code" : "LocalRelationship"
      },
      {
        "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/hipaa-relationship",
        "code" : "18"
      }
    ]
  },
  "period" : {
    "start" : "2000-01-01",
    "end" : "2000-10-31"
  },
  "payor" : [
    {
      "type" : "Organiation",
      "identifier" : {
        "system" : "http://acme-health.com/payer1/payer",
        "value" : "PayerId09876"
      }
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "election-tier"
          }
        ]
      },
      "value" : "Family"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "election-tier"
          }
        ]
      },
      "value" : "dental employee only"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "election-tier"
          }
        ]
      },
      "value" : "vision employee only"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-coverage-class",
            "code" : "group-type"
          }
        ]
      },
      "value" : "HMO"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code" : "group"
          }
        ]
      },
      "value" : "GR12345"
    }
  ]
}