Release 4B 5

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Contract-example-ins-policy.ttl

Example Contract/INS-101 (Turtle)

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

Raw Turtle (+ also see Turtle/RDF Format Specification )

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 -------------------------------------------------------------------

[] a fhir:Contract;
  fhir:Resource.id [ fhir:value "INS-101"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ]
  ];
  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" ]
  ];
  fhir:Contract.subject [
     fhir:index 0;
     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.offer [
       fhir:Contract.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.asset [
       fhir:index 0;
       fhir:Contract.type [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://something/something" ];
           fhir:Coding.code [ fhir:value "RicardianContract" ]
         ]
       ];
       fhir:Contract.subtype [
         fhir:index 0;
         fhir:CodeableConcept.text [ fhir:value "sample" ]
       ];
       fhir:Contract.period [
         fhir:index 0;
         fhir:Period.start [ fhir:value "2017-06-01" ]
       ];
       fhir:Contract.valuedItem [
         fhir:index 0;
         fhir:Contract.entity [
           fhir:CodeableConcept.text [ fhir:value "Ford Bobcat" ]
         ];
         fhir:Contract.identifier [
           fhir:Identifier.system [ fhir:value "http://somewhere.motor-vehicle.com/vin" ];
           fhir:Identifier.value [ fhir:value "XXSVT34-7665t952236" ]
         ];
         fhir:Contract.effectiveTime [ fhir:value "1995" ];
         fhir:Contract.quantity [
           fhir:Quantity.value [ fhir:value "1" ]
         ];
         fhir:Contract.unitPrice [
           fhir:Money.value [ fhir:value "200.00" ];
           fhir:Money.currency [ fhir:value "CAD" ]
         ];
         fhir:Contract.factor [ fhir:value "1.0" ];
         fhir:Contract.points [ fhir:value "1.0" ];
         fhir:Contract.net [
           fhir:Money.value [ fhir:value "200.00" ];
           fhir:Money.currency [ fhir:value "CAD" ]

[a fhir:Contract ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "INS-101"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir: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:identifier ( [
     fhir:system [ fhir:v "http://xyz-insurance.com/forms"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "YCSCWLN(01-2017)" ]
  ] ) ; # 
  fhir:applies [
     fhir:start [ fhir:v "2017-01-01"^^xsd:date ]
  ] ; # 
  fhir:subject ( [
     fhir:reference [ fhir:v "Patient/1" ]
  ] ) ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/contract-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "healthinsurance" ] ;
       fhir:display [ fhir:v "Health Insurance" ]
     ] )
  ] ; # 
  fhir:term ( [
     fhir:offer [
       fhir:text [ fhir:v "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:asset ( [
       fhir:type ( [
         fhir:coding ( [
           fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "urn:uuid:3a48c68c-318d-4c68-8471-4a3c10fcb41b" ] ;
           fhir:display [ fhir:v "RicardianContract" ]
         ] )
       ] ) ;
       fhir:subtype ( [
         fhir:text [ fhir:v "sample" ]
       ] ) ;
       fhir:period ( [
         fhir:start [ fhir:v "2017-06-01"^^xsd:date ]
       ] ) ;
       fhir:valuedItem ( [
         fhir:entity [
           a fhir:CodeableConcept ;
           fhir:text [ fhir:v "Ford Bobcat" ]
         ] ;
         fhir:identifier [
           fhir:system [ fhir:v "http://somewhere.motor-vehicle.com/vin"^^xsd:anyURI ] ;
           fhir:value [ fhir:v "XXSVT34-7665t952236" ]
         ] ;
         fhir:effectiveTime [ fhir:v "1995"^^xsd:gYear ] ;
         fhir:quantity [
           fhir:value [ fhir:v "1"^^xsd:decimal ]
         ] ;
         fhir:unitPrice [
           fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "CAD" ]
         ] ;
         fhir:factor [ fhir:v "1.0"^^xsd:decimal ] ;
         fhir:points [ fhir:v "1.0"^^xsd:decimal ] ;
         fhir:net [
           fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "CAD" ]

         ]
       ] )
     ] ) ;
     fhir:group ( [
       fhir:offer [
         fhir:text [ fhir:v "Eligible Providers" ]

       ]
     ];
     fhir:Contract.group [
       fhir:index 0;
       fhir:Contract.offer [
         fhir:Contract.text [ fhir:value "Eligible Providers" ]
       ]
     ], [
       fhir:index 1;
       fhir:Contract.offer [
         fhir:Contract.text [ fhir:value "Responsibility for Payment" ]

     ] [
       fhir:offer [
         fhir:text [ fhir:v "Responsibility for Payment" ]

       ]
     ], [
       fhir:index 2;
       fhir:Contract.offer [
         fhir:Contract.text [ fhir:value "List of Benefits" ]
       ];
       fhir:Contract.group [
         fhir:index 0;
         fhir:Contract.offer [
           fhir:Contract.text [ fhir:value "Copays" ]
         ];
         fhir:Contract.group [
           fhir:index 0;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Emergency Room Copay" ]

     ] [
       fhir:offer [
         fhir:text [ fhir:v "List of Benefits" ]
       ] ;
       fhir:group ( [
         fhir:offer [
           fhir:text [ fhir:v "Copays" ]
         ] ;
         fhir:group ( [
           fhir:offer [
             fhir:text [ fhir:v "Emergency Room Copay" ]

           ]
         ], [
           fhir:index 1;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Professional Visit Copay" ]

         ] [
           fhir:offer [
             fhir:text [ fhir:v "Professional Visit Copay" ]

           ]
         ] )
       ] [
         fhir:offer [
           fhir:text [ fhir:v "Calendar Year Deductible" ]

         ]
       ], [
         fhir:index 1;
         fhir:Contract.offer [
           fhir:Contract.text [ fhir:value "Calendar Year Deductible" ]
         ]
       ], [
         fhir:index 2;
         fhir:Contract.offer [
           fhir:Contract.text [ fhir:value "Out-Of-Pocket Maximum" ]

       ] [
         fhir:offer [
           fhir:text [ fhir:v "Out-Of-Pocket Maximum" ]

         ]
       ], [
         fhir:index 3;
         fhir:Contract.offer [
           fhir:Contract.text [ fhir:value "Medical Services" ]
         ];
         fhir:Contract.group [
           fhir:index 0;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Ambulance Services" ]

       ] [
         fhir:offer [
           fhir:text [ fhir:v "Medical Services" ]
         ] ;
         fhir:group ( [
           fhir:offer [
             fhir:text [ fhir:v "Ambulance Services" ]

           ]
         ], [
           fhir:index 1;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Dental Services" ]

         ] [
           fhir:offer [
             fhir:text [ fhir:v "Dental Services" ]

           ]
         ], [
           fhir:index 2;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Diagnostic Services" ]

         ] [
           fhir:offer [
             fhir:text [ fhir:v "Diagnostic Services" ]

           ]
         ], [
           fhir:index 3;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Emergency Room Services" ]

         ] [
           fhir:offer [
             fhir:text [ fhir:v "Emergency Room Services" ]

           ]
         ], [
           fhir:index 4;
           fhir:Contract.offer [
             fhir:Contract.text [ fhir:value "Hospital Inpatient Care" ]

         ] [
           fhir:offer [
             fhir:text [ fhir:v "Hospital Inpatient Care" ]

           ]
         ]
       ]
     ]
  ] .

         ] )
       ] )
     ] )
  ] )] . # 


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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.