<?xml version=“1.0” encoding=“UTF-8”?> <Contract xmlns=“hl7.org/fhir”>

 <id value="INS-101"/>

 <meta>
  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>

 <identifier>
    <system value="http://xyz-insurance.com/forms"/>
    <value value="YCSCWLN(01-2017)"/>
 </identifier>

 <applies>
    <start value="2017-01-01"/>
 </applies>

 <subject>
    <reference value="Patient/1"/>
 </subject>

 <type>
    <coding>
       <system value="http://terminology.hl7.org/CodeSystem/contract-type"/>
       <code value="healthinsurance"/>
       <display value="Health Insurance"/>
    </coding>
 </type>

 <term>
    <offer>
       <text 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."/>
    </offer>
    <asset>
       <type>
          <coding>
          <system value="urn:ietf:rfc:3986"/>
          <code value="RicardianContract"/>
       </coding>
       </type>
       <subtype>
          <text value="sample"/>
       </subtype>
       <period>
          <start value="2017-06-01"/>
       </period>
       <valuedItem>
          <entityCodeableConcept>
             <text value="Ford Bobcat"/>
          </entityCodeableConcept>
          <identifier>
             <system value="http://somewhere.motor-vehicle.com/vin"/>
             <value value="XXSVT34-7665t952236"/>
          </identifier>
          <effectiveTime value="1995"/>
          <quantity>
             <value value="1"/>
          </quantity>
          <unitPrice>
             <value value="200.00"/>
             <currency value="CAD"/>
          </unitPrice>
          <factor value="1.0"/>
          <points value="1.0"/>
          <net>
             <value value="200.00"/>
             <currency value="CAD"/>
          </net>
       </valuedItem>
    </asset>
    <group>
       <offer>
          <text value="Eligible Providers"/>
       </offer>
    </group>
    <group>
       <offer>
          <text value="Responsibility for Payment"/>
       </offer>
    </group>
    <group>
       <offer>
          <text value="List of Benefits"/>
       </offer>
       <group>
          <offer>
             <text value="Copays"/>
          </offer>
          <group>
             <offer>
                <text value="Emergency Room Copay"/>
             </offer>
          </group>
          <group>
             <offer>
                <text value="Professional Visit Copay"/>
             </offer>
          </group>
       </group>
       <group>
          <offer>
             <text value="Calendar Year Deductible"/>
          </offer>
       </group>
       <group>
          <offer>
             <text value="Out-Of-Pocket Maximum"/>
          </offer>
       </group>
       <group>
          <offer>
             <text value="Medical Services"/>
          </offer>
          <group>
             <offer>
                <text value="Ambulance Services"/>
             </offer>
          </group>
          <group>
             <offer>
                <text value="Dental Services"/>
             </offer>
          </group>
          <group>
             <offer>
                <text value="Diagnostic Services"/>
             </offer>
          </group>
          <group>
             <offer>
                <text value="Emergency Room Services"/>
             </offer>
          </group>
          <group>
             <offer>
                <text value="Hospital Inpatient Care"/>
             </offer>
          </group>
       </group>
    </group>
 </term>

</Contract>