<Contract xmlns="http://hl7.org/fhir"><id value="INS-101"/><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>