<?xml version="1.0" encoding="UTF-8"?>
<!-- 
 * #%L
 * org.hl7.fhir.r5
 * %%
 * Copyright (C) 2014 - 2019 Health Level 7
 * %%
 * Licensed under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License.
 * You may obtain a copy of the License at
 * 
 *      http://www.apache.org/licenses/LICENSE-2.0
 * 
 * Unless required by applicable law or agreed to in writing, software
 * distributed under the License is distributed on an "AS IS" BASIS,
 * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
 * See the License for the specific language governing permissions and
 * limitations under the License.
 * #L%
 */

/*
  Copyright (c) 2011+, HL7, Inc.
  All rights reserved.
  
  Redistribution and use in source and binary forms, with or without modification, 
  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.
   * Redistributions in binary form must reproduce the above copyright notice, 
     this list of conditions and the following disclaimer in the documentation 
     and/or other materials provided with the distribution.
   * Neither the name of HL7 nor the names of its contributors may be used to 
     endorse or promote products derived from this software without specific 
     prior written permission.
  
  THIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS "AS IS" AND 
  ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED 
  WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARE DISCLAIMED. 
  IN NO EVENT SHALL THE COPYRIGHT HOLDER OR CONTRIBUTORS BE LIABLE FOR ANY DIRECT, 
  INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT 
  NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR 
  PROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON ANY THEORY OF LIABILITY, 
  WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) 
  ARISING IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE 
  POSSIBILITY OF SUCH DAMAGE.
  

  Generated on Tue, May 19, 2026 20:26+0000 for FHIR v6.0.0-ballot4 

  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">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="InsurancePlan">
    <xs:annotation>
      <xs:documentation xml:lang="en">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</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">Identifiers, such as the plan ID and/or group ID associated with the insurance plan.</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="product" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The product that this plan is available under.</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-plan.</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">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</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">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</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.Benefit" 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.Benefit">
    <xs:annotation>
      <xs:documentation xml:lang="en">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</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">InsurancePlan describes the costs to the subscriber or beneficiary associated with benefits, as well as additional information about the offering, such as who administers the plan, a coverage area, contact information, etc.  The specific benefits covered by the plan are described in the `InsuranceProduct` referenced in `InsurancePlan.product`.</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="qualifier" 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>
