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Resource "INS-101" Version "1" (Contract)

Tags:

XML or JSON representation . provenance for this resource

Plan: Your Choice Split Copay (Non-Grandfathered)

Certificate Form Number: YCSCWLN (01-2017)


{
  "resourceType" : "Contract",
  "id" : "INS-101",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:26.020Z"
  },
  "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" : "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"
              }
            }
          ]
        }
      ],
      "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"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}