Productplan-example-onc.xml

A general product plan example with benefit detail (id = "example-onc")

<ProductPlan xmlns="http://hl7.org/fhir">
  <id value="example-onc"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      Sample Plan
    </div> 
  </text> 
    <status value="active"/> 
  <name value="Sample Plan"/> 
  <alias value="PPO Sample Plan"/> 
  <period> 
    <start value="2017-01-01"/> 
  </period> 
  <ownedBy> 
    <reference value="Organization/Test"/> 
    <display value="Test"/> 
  </ownedBy> 
  <administeredBy> 
    <reference value="Organization/Test"/> 
    <display value="Test"/> 
  </administeredBy> 
  <address> 
    <line value="123 Fake Street"/> 
    <city value="Washington"/> 
    <state value="DC"/> 
    <postalCode value="20005"/> 
    <country value="USA"/> 
  </address> 
  <coverageArea> 
    <reference value="Location/2"/> 
    <display value="National"/> 
  </coverageArea> 
  <coverage> 
    <type> 
      <text value="Medical"/> 
    </type> 
    <benefit> 
      <type> 
        <text value="Diagnostic and treatment services"/> 
      </type> 
      <item> 
        <code> 
          <text value="primary care visit"/> 
        </code> 
      </item> 
            <item> 
        <code> 
          <text value="specialty care visit"/> 
        </code> 
      </item> 
    </benefit> 
  </coverage> 
    <!--   May need to change the data type for the value elements. We don't necessarily use currency
   each time (this example has values as currency and values as a percentage)   -->
  <plan> 
    <type> 
      <text value="Standard"/> 
    </type> 
    <premium> 
      <value value="2000"/> 
      <system value="urn:iso:std:iso:4217"/> 
      <code value="USD"/> 
    </premium> 
        <category> 
            <code> 
                <text value="Medical"/> 
            </code> 
            <benefit> 
                <type> 
                    <text value="primary care office visit"/> 
                </type> 
                <cost> 
                    <type> 
                        <text value="copay"/> 
                    </type> 
                    <applicability> 
                        <code value="preferred"/> 
                    </applicability> 
                    <value>  
                        <value value="25"/> 
                        <system value="urn:iso:std:iso:4217"/> 
                        <code value="USD"/> 
                    </value> 
                </cost>     
                <cost> 
                    <type> 
                        <text value="coinsurance"/> 
                    </type> 
                    <applicability> 
                        <code value="participating"/> 
                    </applicability> 
                    <value>  
                        <value value="35"/> 
                        <unit value="%"/> 
                    </value> 
                </cost> 
                <cost> 
                    <type> 
                        <text value="coinsurance"/> 
                    </type> 
                    <applicability> 
                        <code value="non-participating"/> 
                    </applicability> 
                    <value>  
                        <value value="35"/> 
                        <unit value="%"/> 
                    </value> 
                </cost> 
            </benefit> 
            <benefit> 
                <type> 
                    <text value="specialty care office visit"/> 
                </type> 
                <cost> 
                    <type> 
                        <text value="copay"/> 
                    </type> 
                    <applicability> 
                        <code value="preferred"/> 
                    </applicability> 
                    <value>  
                        <value value="35"/> 
                        <system value="urn:iso:std:iso:4217"/> 
                        <code value="USD"/> 
                    </value> 
                </cost>     
                <cost> 
                    <type> 
                        <text value="coinsurance"/> 
                    </type> 
                    <applicability> 
                        <code value="participating"/> 
                    </applicability> 
                    <value>  
                        <value value="35"/> 
                        <unit value="%"/> 
                    </value> 
                </cost> 
                <cost> 
                    <type> 
                        <text value="coinsurance"/> 
                    </type> 
                    <applicability> 
                        <code value="non-participating"/> 
                    </applicability> 
                    <value>  
                        <value value="35"/> 
                        <unit value="%"/> 
                    </value> 
                </cost> 
            </benefit> 
        </category>  
  </plan> 
  <endpoint> 
    <reference value="Endpoint/example"/> 
  </endpoint> 
</ProductPlan>