{

"resourceType": "CoverageEligibilityResponse",
"id": "E2502",
"contained": [
  {
    "resourceType": "Coverage",
    "id": "coverage-1",
    "identifier": [
      {
        "system": "http://benefitsinc.com/certificate",
        "value": "12345"
      }
    ],
    "status": "active",
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "EHCPOL"
        }
      ]
    },
    "subscriber": {
      "reference": "Patient/f201"
    },
    "beneficiary": {
      "reference": "Patient/f201"
    },
    "dependent": "1",
    "relationship": {
      "coding": [
        {
          "code": "self"
        }
      ]
    },
    "payor": [
      {
        "identifier": {
          "system": "http://www.bindb.com/bin",
          "value": "123456"
        }
      }
    ],
    "class": [
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
              "code": "EHCPOL"
            }
          ]
        },
        "value": "CBI35",
        "name": "Corporate Baker's Inc. Plan#35"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code": "subplan"
            }
          ]
        },
        "value": "123",
        "name": "Trainee Part-time Benefits"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code": "sequence"
            }
          ]
        },
        "value": "1"
      }
    ]
  }
],
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
    "value": "8812342"
  }
],
"status": "active",
"purpose": [
  "validation",
  "benefits"
],
"patient": {
  "reference": "Patient/f201"
},
"created": "2014-09-16",
"requestor": {
  "identifier": {
    "system": "http://national.org/clinic",
    "value": "OR1234"
  }
},
"request": {
  "reference": "http://www.BenefitsInc.com/fhir/CoverageEligibilityRequest/225476332405"
},
"outcome": "complete",
"disposition": "Policy is currently in-force.",
"insurer": {
  "reference": "Organization/2"
},
"insurance": [
  {
    "coverage": {
      "reference": "#coverage-1"
    },
    "inforce": true,
    "item": [
      {
        "category": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
              "code": "30",
              "display": "Health Benefit Plan Coverage"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-term",
              "code": "annual"
            }
          ]
        },
        "benefit": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 500000,
              "currency": "USD"
            },
            "usedMoney": {
              "value": 3748.0,
              "currency": "USD"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "copay-maximum"
                }
              ]
            },
            "allowedMoney": {
              "value": 100,
              "currency": "USD"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "copay-percent"
                }
              ]
            },
            "allowedUnsignedInt": 20
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
              "code": "69",
              "display": "Maternity"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-term",
              "code": "annual"
            }
          ]
        },
        "benefit": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 15000,
              "currency": "USD"
            }
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
              "code": "F3",
              "display": "Dental Coverage"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/benefit-term",
              "code": "annual"
            }
          ]
        },
        "benefit": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 2000,
              "currency": "USD"
            }
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
              "code": "F6",
              "display": "Vision Coverage"
            }
          ]
        },
        "excluded": true,
        "name": "Vision",
        "description": "Vision products and services such as exams, glasses and contact lenses."
      }
    ]
  }
],
"form": {
  "coding": [
    {
      "system": "http://national.org/form",
      "code": "ELRSP/2017/01"
    }
  ]
},
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}