{

"resourceType": "Coverage",
"id": "7546D",
"identifier": [
  {
    "system": "http://xyz.com/codes/identifier",
    "value": "AB98761"
  }
],
"status": "active",
"type": {
  "coding": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code": "EHCPOL",
      "display": "extended healthcare"
    }
  ]
},
"subscriber": {
  "reference": "Patient/5"
},
"subscriberId": "AB9876",
"beneficiary": {
  "reference": "Patient/5"
},
"dependent": "1",
"relationship": {
  "coding": [
    {
      "code": "self"
    }
  ]
},
"period": {
  "start": "2011-03-17",
  "end": "2012-03-17"
},
"payor": [
  {
    "reference": "Organization/2"
  }
],
"class": [
  {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code": "group"
        }
      ]
    },
    "value": "WESTAIR",
    "name": "Western Airlines"
  },
  {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code": "plan"
        }
      ]
    },
    "value": "BG4352",
    "name": "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC"
  },
  {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code": "subplan"
        }
      ]
    },
    "value": "D15C9",
    "name": "Platinum"
  }
],
"order": 2,
"network": "5",
"costToBeneficiary": [
  {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
          "code": "gpvisit"
        }
      ]
    },
    "valueMoney": {
      "value": 20.0,
      "currency": "USD"
    },
    "exception": [
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/ex-coverage-financial-exception",
              "code": "retired"
            }
          ]
        },
        "period": {
          "start": "2018-01-01",
          "end": "2018-12-31"
        }
      }
    ]
  }
],
"contract": [
  {
    "reference": "Contract/INS-101"
  }
],
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}