<?xml version="1.0" encoding="UTF-8"?>

<Coverage xmlns="http://hl7.org/fhir">  
    <id value="f91c96333cf84e6d80fee0427f822bd9"/>  
    <meta> 
        <security> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>  
            <code value="HTEST"/>  
            <display value="test health data"/> 
        </security> 
    </meta>  
    <text> 
        <status value="generated"/>  
        <div xmlns="http://www.w3.org/1999/xhtml">  
            <p>Touchstone Test Data - Touchstone Test Data - Coverage: Preferred Provider Organization policy</p> 
        </div> 
    </text>  
    <identifier> 
        <system value="http://benefitsinc.com/certificate"/>  
        <value value="02118670-6986"/> 
    </identifier>  
    <status value="draft"/>  
    <type> 
        <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>  
            <code value="EHCPOL"/>  
            <display value="extended healthcare"/> 
        </coding> 
    </type>  
    <subscriber> 
        <reference value="Patient/1d6c8c78eaad4d58af4504522720fdfa"/> 
    </subscriber>  
    <beneficiary> 
        <reference value="Patient/1d6c8c78eaad4d58af4504522720fdfa"/> 
    </beneficiary>  
    <relationship> 
        <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>  
            <code value="self"/>  
            <display value="Self"/> 
        </coding> 
    </relationship>  
    <period> 
        <start value="2018-12-01"/>  
        <end value="2019-11-30"/> 
    </period>  
    <payor> 
        <identifier> 
            <system value="http://benefitsinc.com/insurer"/>  
            <value value="Pm1Yvlg7-N1I2kTTcyJCL"/> 
        </identifier>  
        <display value="Pm1Yvlg7-N1I2kTTcyJCL"/> 
    </payor> 
</Coverage>