Contract-example-ins-policy.json

Health Insurance Policy

{
  "resourceType" : "Contract",
  "id" : "INS-101",
  "text" : {
    "status" : "generated",
    "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>"
  },
  "identifier" : [{
    "system" : "http://xyz-insurance.com/forms",
    "value" : "YCSCWLN(01-2017)"
  }],
  "applies" : {
    "start" : "2017-01-01"
  },
  "subject" : [{
    "reference" : "Patient/1"
  }],
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/contract-type",
      "code" : "healthinsurance",
      "display" : "Health Insurance"
    }]
  },
  "term" : [{
    "offer" : {
      "text" : "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."
    },
    "asset" : [{
      "type" : [{
        "coding" : [{
          "system" : "http://something/something",
          "code" : "RicardianContract"
        }]
      }],
      "subtype" : [{
        "text" : "sample"
      }],
      "period" : [{
        "start" : "2017-06-01"
      }],
      "valuedItem" : [{
        "entityCodeableConcept" : {
          "text" : "Ford Bobcat"
        },
        "identifier" : {
          "system" : "http://somewhere.motor-vehicle.com/vin",
          "value" : "XXSVT34-7665t952236"
        },
        "effectiveTime" : "1995",
        "quantity" : {
          "value" : 1
        },
        "unitPrice" : {
          "value" : 200.00,
          "currency" : "CAD"
        },
        "factor" : 1.0,
        "points" : 1.0,
        "net" : {
          "value" : 200.00,
          "currency" : "CAD"
        }
      }]
    }],
    "group" : [{
      "offer" : {
        "text" : "Eligible Providers"
      }
    },
    {
      "offer" : {
        "text" : "Responsibility for Payment"
      }
    },
    {
      "offer" : {
        "text" : "List of Benefits"
      },
      "group" : [{
        "offer" : {
          "text" : "Copays"
        },
        "group" : [{
          "offer" : {
            "text" : "Emergency Room Copay"
          }
        },
        {
          "offer" : {
            "text" : "Professional Visit Copay"
          }
        }]
      },
      {
        "offer" : {
          "text" : "Calendar Year Deductible"
        }
      },
      {
        "offer" : {
          "text" : "Out-Of-Pocket Maximum"
        }
      },
      {
        "offer" : {
          "text" : "Medical Services"
        },
        "group" : [{
          "offer" : {
            "text" : "Ambulance Services"
          }
        },
        {
          "offer" : {
            "text" : "Dental Services"
          }
        },
        {
          "offer" : {
            "text" : "Diagnostic Services"
          }
        },
        {
          "offer" : {
            "text" : "Emergency Room Services"
          }
        },
        {
          "offer" : {
            "text" : "Hospital Inpatient Care"
          }
        }]
      }]
    }]
  }]
}