This page is part of the FHIR Specification (v4.5.0: R5 Preview #3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4
Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Not linked to any defined compartments |
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Health Insurance Policy
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- <http://hl7.org/fhir/Contract/INS-101> a fhir:Contract; fhir:nodeRole fhir:treeRoot; fhir:Resource.id [ fhir:value "INS-101"]; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "generated" ]; fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <p>Plan: Your Choice Split Copay (Non-Grandfathered)</p>\n <p>Certificate Form Number: YCSCWLN (01-2017)</p>\n </div>" ]; fhir:Contract.identifier [ fhir:index 0; fhir:Identifier.system [ fhir:value "http://xyz-insurance.com/forms" ]; fhir:Identifier.value [ fhir:value "YCSCWLN(01-2017)" ] ]; fhir:Contract.applies [ fhir:Period.start [ fhir:value "2017-01-01"^^xsd:date ] ]; fhir:Contract.subject [ fhir:index 0; fhir:link <http://hl7.org/fhir/Patient/1>; fhir:Reference.reference [ fhir:value "Patient/1" ] ]; fhir:Contract.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/contract-type" ]; fhir:Coding.code [ fhir:value "healthinsurance" ]; fhir:Coding.display [ fhir:value "Health Insurance" ] ] ]; fhir:Contract.term [ fhir:index 0; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "The benefits, limitations, exclusions and other coverage provisions in this booklet are subject to the terms of our contract with the Group. This booklet is a part of that contract, which is on file in the Group's office." ] ]; fhir:Contract.term.asset [ fhir:index 0; fhir:Contract.term.asset.type [ fhir:index 0; fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "urn:ietf:rfc:3986" ]; fhir:Coding.code [ fhir:value "RicardianContract" ] ] ]; fhir:Contract.term.asset.subtype [ fhir:index 0; fhir:CodeableConcept.text [ fhir:value "sample" ] ]; fhir:Contract.term.asset.period [ fhir:index 0; fhir:Period.start [ fhir:value "2017-06-01"^^xsd:date ] ]; fhir:Contract.term.asset.valuedItem [ fhir:index 0; fhir:Contract.term.asset.valuedItem.entityCodeableConcept [ fhir:CodeableConcept.text [ fhir:value "Ford Bobcat" ] ]; fhir:Contract.term.asset.valuedItem.identifier [ fhir:Identifier.system [ fhir:value "http://somewhere.motor-vehicle.com/vin" ]; fhir:Identifier.value [ fhir:value "XXSVT34-7665t952236" ] ]; fhir:Contract.term.asset.valuedItem.effectiveTime [ fhir:value "1995"^^xsd:gYear ]; fhir:Contract.term.asset.valuedItem.quantity [ fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ] ]; fhir:Contract.term.asset.valuedItem.unitPrice [ fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "CAD" ] ]; fhir:Contract.term.asset.valuedItem.factor [ fhir:value "1.0"^^xsd:decimal ]; fhir:Contract.term.asset.valuedItem.points [ fhir:value "1.0"^^xsd:decimal ]; fhir:Contract.term.asset.valuedItem.net [ fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ]; fhir:Money.currency [ fhir:value "CAD" ] ] ] ]; fhir:Contract.term.group [ fhir:index 0; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Eligible Providers" ] ] ], [ fhir:index 1; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Responsibility for Payment" ] ] ], [ fhir:index 2; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "List of Benefits" ] ]; fhir:Contract.term.group [ fhir:index 0; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Copays" ] ]; fhir:Contract.term.group [ fhir:index 0; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Emergency Room Copay" ] ] ], [ fhir:index 1; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Professional Visit Copay" ] ] ] ], [ fhir:index 1; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Calendar Year Deductible" ] ] ], [ fhir:index 2; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Out-Of-Pocket Maximum" ] ] ], [ fhir:index 3; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Medical Services" ] ]; fhir:Contract.term.group [ fhir:index 0; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Ambulance Services" ] ] ], [ fhir:index 1; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Dental Services" ] ] ], [ fhir:index 2; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Diagnostic Services" ] ] ], [ fhir:index 3; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Emergency Room Services" ] ] ], [ fhir:index 4; fhir:Contract.term.offer [ fhir:Contract.term.offer.text [ fhir:value "Hospital Inpatient Care" ] ] ] ] ] ] . <http://hl7.org/fhir/Patient/1> a fhir:Patient . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/Contract/INS-101.ttl> a owl:Ontology; owl:imports fhir:fhir.ttl; owl:versionIRI <http://build.fhir.org/Contract/INS-101.ttl> . # -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.