Release 4 4B

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Contract-example-ins-policy.json

Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Not linked to any defined compartments

Raw JSON ( canonical form + also see JSON Format Specification )

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>"

  "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"

  "identifier" : [{
    "system" : "http://xyz-insurance.com/forms",
    "value" : "YCSCWLN(01-2017)"
  }],
  "applies" : {
    "start" : "2017-01-01"

  },
  "subject": [

  "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"
      }
    },

    {
      "reference": "Patient/1"
    }
  ],
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/contract-type",
        "code": "healthinsurance",
        "display": "Health Insurance"

      "offer" : {
        "text" : "Responsibility for Payment"

      }
    ]
  },
  "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."

      "offer" : {
        "text" : "List of Benefits"

      },
      "asset": [

      "group" : [{
        "offer" : {
          "text" : "Copays"
        },
        "group" : [{
          "offer" : {
            "text" : "Emergency Room Copay"
          }
        },

        {
          "type": [
            {
              "coding": [
                {
                  "system": "urn:ietf:rfc:3986",
                  "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"
              }
            }
          ]

          "offer" : {
            "text" : "Professional Visit Copay"
          }
        }]
      },
      {
        "offer" : {
          "text" : "Calendar Year Deductible"

        }
      ],
      "group": [

      },
      {
        "offer" : {
          "text" : "Out-Of-Pocket Maximum"
        }
      },
      {
        "offer" : {
          "text" : "Medical Services"
        },
        "group" : [{
          "offer" : {
            "text" : "Ambulance Services"
          }
        },

        {
          "offer": {
            "text": "Eligible Providers"

          "offer" : {
            "text" : "Dental Services"

          }
        },
        {
          "offer": {
            "text": "Responsibility for Payment"

          "offer" : {
            "text" : "Diagnostic Services"

          }
        },
        {
          "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"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]

          "offer" : {
            "text" : "Emergency Room Services"
          }
        },
        {
          "offer" : {
            "text" : "Hospital Inpatient Care"
          }
        }]
      }]
    }]
  }]

}

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.