{ "resourceType": "Contract", "id": "INS-101", "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": 200.0, "currency": "CAD" }, "factor": 1.0, "points": 1.0, "net": { "value": 200.0, "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" } } ] } ] } ] } ], "meta": { "tag": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason", "code": "HTEST", "display": "test health data" } ] } }