{
    "resourceType"  : "Coverage",
    "id"            : "",
    "identifier"    : [{
        "use" : "",
        "type": { 
            "coding"  : [{
                "system"        : "http://terminology.hl7.org/CodeSystem/organization-type",
                "version"       : "",
                "code"          : "pay",
                "display"       : "Payer",
                "userSelected"  : true
            }],
            "text"  : ""            
        },
        "system"  : "",
        "value"   : "",
        "period"  : {"start" : "", "end" : ""},
        "assigner": {
            "reference" : "",
            "display"   : ""
        }
    }],
    "status"        : "active",
    "kind"          : "",
    "paymentBy"     : [{
        "party"     : {
            "reference" : "",
            "display"   : ""
        },
        "responsibility": ""
    }],
    "type"          : {
        "coding": [{
            "system"        : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "version"       : "",
            "code"          : "EHCPOL",
            "display"       : "extended healthcare",
            "userSelected"  : ""
        }],
        "text": "BPJS Kesehatan Coverage"
    },
    "policyHolder"  : {
        "reference" : "",
        "display"   : ""
    },
    "subscriber": {
        "reference" : "Patient/12345",
        "display"   : "Budi Santoso"
    },
    "subscriberId"  : [{
        "coding": [{
            "system"        : "",
            "version"       : "",
            "code"          : "",
            "display"       : "",
            "userSelected"  : ""
        }],
        "text": ""
    }],
    "beneficiary": {
        "reference" : "Patient/12345",
        "display"   : "Budi Santoso"
    },
    "dependent"     : "",
    "relationship"  : {
        "coding": [{
            "system"        : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
            "version"       : "",
            "code"          : "self",
            "display"       : "Self",
            "userSelected"  : ""
        }],
        "text"  : ""
    },
    "period"    : {"start": "2020-01-01","end": "9999-12-31"},
    "insurer"   : {
        "reference" : "",
        "display"   : ""
    },
    "class": [{
        "type"  : {
            "coding": [{
                "system"        : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "version"       : "",
                "code"          : "group",
                "display"       : "Group",
                "userSelected"  : ""
            }],
            "text"  : ""
        },
        "value" : {
            "use" : "",
            "type": { 
                "coding"  : [{
                    "system"        : "",
                    "version"       : "",
                    "code"          : "PPU",
                    "display"       : "Pekerja Penerima Upah",
                    "userSelected"  : false
                }],
                "text"  : "Pekerja Penerima Upah"            
            },
            "system"  : "",
            "value"   : "",
            "period"  : {"start" : "", "end" : ""},
            "assigner": {
                "reference" : "",
                "display"   : ""
            }
        },
        "name"  : "Pekerja Penerima Upah"
    },
    {
        "type": {
            "coding": [{
                "system"        : "http://terminology.hl7.org/CodeSystem/coverage-class",
                "version"       : "",
                "code"          : "plan",
                "display"       : "Plan",
                "userSelected"  : ""
            }],
            "text"  : ""
        },
        "value": {
            "use" : "",
            "type": { 
                "coding"  : [{
                    "system"        : "",
                    "version"       : "",
                    "code"          : "",
                    "display"       : "Kelas 2",
                    "userSelected"  : true
                }],
                "text"  : ""            
            },
            "system"  : "",
            "value"   : "",
            "period"  : {"start" : "", "end" : ""},
            "assigner": {
                "reference" : "",
                "display"   : ""
            }
        },
        "name"  : ""
    }],
    "order"     : 0,
    "network"   : "RSUD Dr. Saiful Anwar",
    "costToBeneficiary" : [{
        "type"      : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        },
        "category"  : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        },
        "network"   : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        },
        "unit"      : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        },
        "term"      : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        }
    }],
    "value" : {
        "valueQuantity" : "",
        "valueMoney"    : {
            "value"     : 0,
            "currency"  : ""
        }
    },
    "exception" : [{
        "type"      : {
            "coding"  : [{
                "system"        : "",
                "version"       : "",
                "code"          : "",
                "display"       : "Kelas 2",
                "userSelected"  : true
            }],
            "text"  : ""  
        },
        "period"    : {"start" : "", "end" : ""}
    }],
    "subrogation"   : 0,
    "contact"   : {
        "reference" : "",
        "display"   : ""
    },
    "insurancePlan" : {
        "reference" : "",
        "display"   : ""
    }
}