<?xml version="1.0" encoding="UTF-8"?>
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/*
  Copyright (c) 2011+, HL7, Inc.
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  are permitted provided that the following conditions are met:
  
   * Redistributions of source code must retain the above copyright notice, this 
     list of conditions and the following disclaimer.
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     endorse or promote products derived from this software without specific 
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  IN NO EVENT SHALL THE COPYRIGHT HOLDER OR CONTRIBUTORS BE LIABLE FOR ANY DIRECT, 
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  Generated on Sun, Mar 26, 2023 15:21+1100 for FHIR v5.0.0 

  Note: the schemas &amp; schematrons do not contain all of the rules about what makes resources
  valid. Implementers will still need to be familiar with the content of the specification and with
  any profiles that apply to the resources in order to make a conformant implementation.

-->
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" targetNamespace="http://hl7.org/fhir" elementFormDefault="qualified" version="1.0">
  <xs:include schemaLocation="fhir-base.xsd"/>
  <xs:element name="InsurancePlan" type="InsurancePlan">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="InsurancePlan">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="DomainResource">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">Business identifiers assigned to this health insurance product which remain constant as the resource is updated and propagates from server to server.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="status" minOccurs="0" maxOccurs="1" type="PublicationStatus">
            <xs:annotation>
              <xs:documentation xml:lang="en">The current state of the health insurance product.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="type" minOccurs="0" maxOccurs="unbounded" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The kind of health insurance product.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="name" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">Official name of the health insurance product as designated by the owner.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="alias" minOccurs="0" maxOccurs="unbounded" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">A list of alternate names that the product is known as, or was known as in the past.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="period" minOccurs="0" maxOccurs="1" type="Period">
            <xs:annotation>
              <xs:documentation xml:lang="en">The period of time that the health insurance product is available.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="ownedBy" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The entity that is providing  the health insurance product and underwriting the risk.  This is typically an insurance carriers, other third-party payers, or health plan sponsors comonly referred to as 'payers'.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="administeredBy" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">An organization which administer other services such as underwriting, customer service and/or claims processing on behalf of the health insurance product owner.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="coverageArea" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The geographic region in which a health insurance product's benefits apply.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="contact" minOccurs="0" maxOccurs="unbounded" type="ExtendedContactDetail">
            <xs:annotation>
              <xs:documentation xml:lang="en">The contact details of communication devices available relevant to the specific Insurance Plan/Product. This can include addresses, phone numbers, fax numbers, mobile numbers, email addresses and web sites.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="endpoint" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The technical endpoints providing access to services operated for the health insurance product.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Reference to the network included in the health insurance product.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="coverage" type="InsurancePlan.Coverage" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Details about the coverage offered by the insurance product.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="plan" type="InsurancePlan.Plan" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Details about an insurance plan.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Coverage">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of coverage  (Medical; Dental; Mental Health; Substance Abuse; Vision; Drug; Short Term; Long Term Care; Hospice; Home Health).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Reference to the network that providing the type of coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="benefit" type="InsurancePlan.Benefit" minOccurs="1" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Specific benefits under this type of coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Benefit">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of benefit (primary care; speciality care; inpatient; outpatient).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="requirement" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">The referral requirements to have access/coverage for this benefit.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="limit" type="InsurancePlan.Limit" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">The specific limits on the benefit.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Limit">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="value" minOccurs="0" maxOccurs="1" type="Quantity">
            <xs:annotation>
              <xs:documentation xml:lang="en">The maximum amount of a service item a plan will pay for a covered benefit.  For examples. wellness visits, or eyeglasses.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="code" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The specific limit on the benefit.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Plan">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">Business identifiers assigned to this health insurance plan which remain constant as the resource is updated and propagates from server to server.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of plan. For example, &quot;Platinum&quot; or &quot;High Deductable&quot;.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="coverageArea" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The geographic region in which a health insurance plan's benefits apply.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="network" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Reference to the network that providing the type of coverage.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="generalCost" type="InsurancePlan.GeneralCost" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Overall costs associated with the plan.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="specificCost" type="InsurancePlan.SpecificCost" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Costs associated with the coverage provided by the product.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.GeneralCost">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of cost.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="groupSize" minOccurs="0" maxOccurs="1" type="positiveInt">
            <xs:annotation>
              <xs:documentation xml:lang="en">Number of participants enrolled in the plan.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="cost" minOccurs="0" maxOccurs="1" type="Money">
            <xs:annotation>
              <xs:documentation xml:lang="en">Value of the cost.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="comment" minOccurs="0" maxOccurs="1" type="string">
            <xs:annotation>
              <xs:documentation xml:lang="en">Additional information about the general costs associated with this plan.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.SpecificCost">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="category" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">General category of benefit (Medical; Dental; Vision; Drug; Mental Health; Substance Abuse; Hospice, Home Health).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="benefit" type="InsurancePlan.Benefit1" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">List of the specific benefits under this category of benefit.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Benefit1">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of specific benefit (preventative; primary care office visit; speciality office visit; hospitalization; emergency room; urgent care).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="cost" type="InsurancePlan.Cost" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">List of the costs associated with a specific benefit.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="InsurancePlan.Cost">
    <xs:annotation>
      <xs:documentation xml:lang="en">Details of a Health Insurance product/plan provided by an organization.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="type" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Type of cost (copay; individual cap; family cap; coinsurance; deductible).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="applicability" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Whether the cost applies to in-network or out-of-network providers (in-network; out-of-network; other).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="qualifiers" minOccurs="0" maxOccurs="unbounded" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Additional information about the cost, such as information about funding sources (e.g. HSA, HRA, FSA, RRA).</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="value" minOccurs="0" maxOccurs="1" type="Quantity">
            <xs:annotation>
              <xs:documentation xml:lang="en">The actual cost value. (some of the costs may be represented as percentages rather than currency, e.g. 10% coinsurance).</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
</xs:schema>
