<?xml version="1.0" encoding="UTF-8"?><Contract xmlns="http://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>
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">
         <p>Plan: Your Choice Split Copay (Non-Grandfathered)</p>
         <p>Certificate Form Number: YCSCWLN (01-2017)</p>
      </div>
  </text>
  <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="urn:uuid:3a48c68c-318d-4c68-8471-4a3c10fcb41b"/>
          <display 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>