{

"resourceType": "EligibilityResponse",
"id": "E2502",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
},
"contained": [
  {
    "resourceType": "Patient",
    "id": "patient-1",
    "name": [
      {
        "use": "official",
        "family": "Donald",
        "given": [
          "Duck"
        ]
      }
    ],
    "gender": "male",
    "birthDate": "1986-05-17",
    "address": [
      {
        "use": "home",
        "line": [
          "1234 Main Street"
        ],
        "city": "Vancouver",
        "postalCode": "V2H1Y3",
        "country": "CAD"
      }
    ]
  },
  {
    "resourceType": "Coverage",
    "id": "coverage-1",
    "identifier": [
      {
        "system": "http://benefitsinc.com/certificate",
        "value": "12345"
      }
    ],
    "status": "active",
    "type": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/v3/ActCode",
          "code": "EHCPOL"
        }
      ]
    },
    "subscriber": {
      "reference": "#patient-1"
    },
    "beneficiary": {
      "reference": "#patient-1"
    },
    "relationship": {
      "coding": [
        {
          "code": "self"
        }
      ]
    },
    "payor": [
      {
        "identifier": {
          "system": "http://www.bindb.com/bin",
          "value": "123456"
        }
      }
    ],
    "grouping": {
      "plan": "CBI35",
      "planDisplay": "Corporate Baker's Inc. Plan#35",
      "subPlan": "123",
      "subPlanDisplay": "Trainee Part-time Benefits"
    },
    "dependent": "1",
    "sequence": "1"
  }
],
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/eligibilityresponse",
    "value": "8812342"
  }
],
"status": "active",
"created": "2014-09-16",
"requestProvider": {
  "identifier": {
    "system": "http://national.org/provider",
    "value": "PR9876"
  }
},
"requestOrganization": {
  "identifier": {
    "system": "http://national.org/clinic",
    "value": "OR1234"
  }
},
"request": {
  "reference": "http://www.BenefitsInc.com/fhir/EligibilityRequest/225476332405"
},
"outcome": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/remittance-outcome",
      "code": "complete"
    }
  ]
},
"disposition": "Policy is currently in-force.",
"insurer": {
  "reference": "Organization/2"
},
"inforce": true,
"insurance": [
  {
    "coverage": {
      "reference": "#coverage-1"
    },
    "contract": {
      "reference": "http://www.BenefitsInc.com/fhir/Contract/NBU22547"
    },
    "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": "USD"
            },
            "usedMoney": {
              "value": 3748.00,
              "system": "urn:iso:std:iso:4217",
              "code": "USD"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "code": "copay-maximum"
                }
              ]
            },
            "allowedMoney": {
              "value": 100,
              "system": "urn:iso:std:iso:4217",
              "code": "USD"
            }
          },
          {
            "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": "USD"
            }
          }
        ]
      },
      {
        "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": "USD"
            }
          }
        ]
      },
      {
        "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"
            }
          ]
        },
        "excluded": true,
        "name": "Vision",
        "description": "Vision products and services such as exams, glasses and contatc lenses."
      }
    ]
  }
],
"form": {
  "coding": [
    {
      "system": "http://national.org/form",
      "code": "ELRSP/2017/01"
    }
  ]
}

}