{

"resourceType": "EligibilityResponse",
"id": "E2501",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
},
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/eligibilityresponse",
    "value": "881234"
  }
],
"status": "active",
"created": "2014-08-16",
"request": {
  "reference": "http://www.BenefitsInc.com/fhir/EligibilityRequest/225476332402"
},
"outcome": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/remittance-outcome",
      "code": "complete"
    }
  ]
},
"disposition": "Policy is currently in-force.",
"insurer": {
  "reference": "Organization/2"
},
"inforce": true,
"insurance": [
  {
    "benefitBalance": [
      {
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-category",
              "code": "medical"
            }
          ]
        },
        "subCategory": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-subcategory",
              "code": "30",
              "display": "Health Benefit Plan Coverage"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-term",
              "code": "annual"
            }
          ]
        },
        "financial": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 500000,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "copay-maximum"
                }
              ]
            },
            "allowedMoney": {
              "value": 100,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "copay-percent"
                }
              ]
            },
            "allowedUnsignedInt": 20
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-category",
              "code": "medical"
            }
          ]
        },
        "subCategory": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-subcategory",
              "code": "69",
              "display": "Maternity"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-term",
              "code": "annual"
            }
          ]
        },
        "financial": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 15000,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-category",
              "code": "oral"
            }
          ]
        },
        "subCategory": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-subcategory",
              "code": "F3",
              "display": "Dental Coverage"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-term",
              "code": "annual"
            }
          ]
        },
        "financial": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 2000,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-category",
              "code": "vision"
            }
          ]
        },
        "subCategory": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-subcategory",
              "code": "F6",
              "display": "Vision Coverage"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-term",
              "code": "annual"
            }
          ]
        },
        "financial": [
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 400,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          }
        ]
      },
      {
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-category",
              "code": "vision"
            }
          ]
        },
        "subCategory": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-subcategory",
              "code": "49",
              "display": "Hospital Room and Board"
            }
          ]
        },
        "network": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-network",
              "code": "in"
            }
          ]
        },
        "unit": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-unit",
              "code": "individual"
            }
          ]
        },
        "term": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/benefit-term",
              "code": "day"
            }
          ]
        },
        "financial": [
          {
            "type": {
              "coding": [
                {
                  "code": "room"
                }
              ]
            },
            "allowedString": "shared"
          },
          {
            "type": {
              "coding": [
                {
                  "code": "benefit"
                }
              ]
            },
            "allowedMoney": {
              "value": 600,
              "system": "urn:iso:std:iso:4217",
              "code": "SAR"
            }
          }
        ]
      }
    ]
  }
]

}