InsuranceProduct Example: insuranceproduct-example-onc

Narrative

Sample Plan

Example XML

<?xml version="1.0" encoding="UTF-8"?>
<InsuranceProduct xmlns="http://hl7.org/fhir">
    <id value="example-onc" />
    <text>
        <status value="generated" />
        <div xmlns="http://www.w3.org/1999/xhtml">
            Sample Plan
        </div>
    </text>
    <identifier>
      <system value="urn:ietf:rfc:3986"/>
      <value value="urn:oid:2.16.840.1.113883.4.642.33.3"/>
    </identifier>
    <status value="active" />
    <name value="Sample Plan" />
    <alias value="PPO Sample Plan" />
    <period>
        <start value="2017-01-01" />
    </period>
    <ownedBy>
        <reference value="Organization/Test" />
        <display value="Test" />
    </ownedBy>
    <administeredBy>
        <reference value="Organization/Test" />
        <display value="Test" />
    </administeredBy>
    <contact>
        <address>
            <line value="123 Fake Street" />
            <city value="Washington" />
            <state value="DC" />
            <postalCode value="20005" />
            <country value="USA" />
        </address>
    </contact>
    <coverageArea>
        <reference value="Location/2" />
        <display value="National" />
    </coverageArea>
    <coverage>
        <type>
            <text value="Medical" />
        </type>
        <benefit>
            <type>
                <text value="Diagnostic and treatment services" />
            </type>
            <limit>
                <code>
                    <text value="primary care visit" />
                </code>
            </limit>
            <limit>
                <code>
                    <text value="specialty care visit" />
                </code>
            </limit>
        </benefit>
    </coverage>
    <!-- May need to change the data type for the value elements. We don't necessarily use currency each time (this example has values as currency and values as a percentage) -->
    <plan>
        <type>
            <text value="Standard" />
        </type>
        <generalCost>
            <cost>
                <value value="2000" />
                <currency value="USD" />
            </cost>
        </generalCost>
        <specificCost>
            <category>
                <text value="Medical" />
            </category>
            <benefit>
                <type>
                    <text value="primary care office visit" />
                </type>
                <cost>
                    <type>
                        <text value="copay" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="in-network" />
                        </coding>
                        <text value="preferred" />
                    </applicability>
                    <value>
                        <value value="25" />
                        <unit value="USD" />
                    </value>
                </cost>
                <cost>
                    <type>
                        <text value="coinsurance" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="in-network" />
                        </coding>
                        <text value="participating" />
                    </applicability>
                    <value>
                        <value value="35" />
                        <unit value="%" />
                    </value>
                </cost>
                <cost>
                    <type>
                        <text value="coinsurance" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="out-of-network" />
                        </coding>
                        <text value="non-participating" />
                    </applicability>
                    <value>
                        <value value="35" />
                        <unit value="%" />
                    </value>
                </cost>
            </benefit>
            <benefit>
                <type>
                    <text value="specialty care office visit" />
                </type>
                <cost>
                    <type>
                        <text value="copay" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="in-network" />
                        </coding>
                        <text value="preferred" />
                    </applicability>
                    <value>
                        <value value="35" />
                        <unit value="USD" />
                    </value>
                </cost>
                <cost>
                    <type>
                        <text value="coinsurance" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="in-network" />
                        </coding>
                        <text value="participating" />
                    </applicability>
                    <value>
                        <value value="35" />
                        <unit value="%" />
                    </value>
                </cost>
                <cost>
                    <type>
                        <text value="coinsurance" />
                    </type>
                    <applicability>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/applicability" />
                            <code value="out-of-network" />
                        </coding>
                        <text value="non-participating" />
                    </applicability>
                    <value>
                        <value value="35" />
                        <unit value="%" />
                    </value>
                </cost>
            </benefit>
        </specificCost>
    </plan>
    <endpoint>
        <reference value="Endpoint/example" />
    </endpoint>
</InsuranceProduct>