Health Insurance Policy (id = "INS-101")

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


   

   
      
      
         
         
      
   

   
      
      
   
   
   
      
   
   
   
      
   
   
   
      
         
         
         
      
   
   
   
      
         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.
      
      
         
            
            
            
         
         
         
            
         
         
            
         
         
            
               
            
            
               
               
            
            
            
               
            
            
               
               
            
            
            
            
               
               
            
         
      
      
         
            
         
      
      
         
            
         
      
      
         
            
         
         
            
               
            
            
               
                  
               
            
            
               
                  
               
            
         
         
            
               
            
         
         
            
               
            
         
         
            
               
            
            
               
                  
               
            
            
               
                  
               
            
            
               
                  
               
            
            
               
                  
               
            
            
               
                  
               
            
         
      
   

<Contract xmlns="http://hl7.org/fhir">
  <id value="INS-101"/> 
  <text> 
    <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">
         <p> Plan: Your Choice Split Copay (Non-Grandfathered)</p> 
         <p> Certificate Form Number: YCSCWLN (01-2017)</p> 
      </div> 
  </text> 
  <identifier> 
    <system value="http://xyz-insurance.com/forms"/> 
    <value value="YCSCWLN(01-2017)"/> 
  </identifier> 
  <applies> 
    <start value="2017-01-01"/> 
  </applies> 
  <subject> 
    <reference value="Patient/1"/> 
  </subject> 
  <type> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/contract-type"/> 
      <code value="healthinsurance"/> 
      <display value="Health Insurance"/> 
    </coding> 
  </type> 
  <term> 
    <offer> 
      <text 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."/> 
    </offer>     <asset>       <type>         <coding>           <system value="urn:ietf:rfc:3986"/>           <code value="urn:uuid:3a48c68c-318d-4c68-8471-4a3c10fcb41b"/>           <display value="RicardianContract"/>         </coding>       </type>       <subtype>         <text value="sample"/>       </subtype>       <period>         <start value="2017-06-01"/>       </period>       <valuedItem>         <entityCodeableConcept>           <text value="Ford Bobcat"/>         </entityCodeableConcept>         <identifier>           <system value="http://somewhere.motor-vehicle.com/vin"/>           <value value="XXSVT34-7665t952236"/>         </identifier>         <effectiveTime value="1995"/>         <quantity>           <value value="1"/>         </quantity>         <unitPrice>           <value value="200.00"/>           <currency value="CAD"/>         </unitPrice>         <factor value="1.0"/>         <points value="1.0"/>         <net>           <value value="200.00"/>           <currency value="CAD"/>         </net>       </valuedItem>     </asset>     <group>       <offer>         <text value="Eligible Providers"/>       </offer>     </group>     <group>       <offer>         <text value="Responsibility for Payment"/>       </offer>     </group>     <group>       <offer>         <text value="List of Benefits"/>       </offer>       <group>         <offer>           <text value="Copays"/>         </offer>         <group>           <offer>             <text value="Emergency Room Copay"/>           </offer>         </group>         <group>           <offer>             <text value="Professional Visit Copay"/>           </offer>         </group>       </group>       <group>         <offer>           <text value="Calendar Year Deductible"/>         </offer>       </group>       <group>         <offer>           <text value="Out-Of-Pocket Maximum"/>         </offer>       </group>       <group>         <offer>           <text value="Medical Services"/>         </offer>         <group>           <offer>             <text value="Ambulance Services"/>           </offer>         </group>         <group>           <offer>             <text value="Dental Services"/>           </offer>         </group>         <group>           <offer>             <text value="Diagnostic Services"/>           </offer>         </group>         <group>           <offer>             <text value="Emergency Room Services"/>           </offer>         </group>         <group>           <offer>             <text value="Hospital Inpatient Care"/>           </offer>         </group>       </group>     </group>   </term> 


</

Contract

>