{
  "resourceType" : "InsurancePlan",
  "resourceDefinition" : "http://hl7.org/fhir/StructureDefinition/InsurancePlan|0.1.0",
  "id" : "example-onc",
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan example-onc</b></p><a name=\"example-onc\"> </a><a name=\"hcexample-onc\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p></div><p><b>type</b>: <span title=\"Codes:\">Standard</span></p><blockquote><p><b>generalCost</b></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>2000</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:\">Medical</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:\">primary care office visit</span></p><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">copay</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">preferred</span></p><p><b>value</b>: 25 USD</p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">coinsurance</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">participating</span></p><p><b>value</b>: 35 %</p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">coinsurance</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability out-of-network}\">non-participating</span></p><p><b>value</b>: 35 %</p></blockquote></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:\">specialty care office visit</span></p><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">copay</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">preferred</span></p><p><b>value</b>: 35 USD</p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">coinsurance</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability in-network}\">participating</span></p><p><b>value</b>: 35 %</p></blockquote><blockquote><p><b>cost</b></p><p><b>type</b>: <span title=\"Codes:\">coinsurance</span></p><p><b>applicability</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/applicability out-of-network}\">non-participating</span></p><p><b>value</b>: 35 %</p></blockquote></blockquote></blockquote></div>"
  },
  "type" : {
    "text" : "Standard"
  },
  "generalCost" : [{
    "cost" : {
      "value" : 2000,
      "currency" : "USD"
    }
  }],
  "specificCost" : [{
    "category" : {
      "text" : "Medical"
    },
    "benefit" : [{
      "type" : {
        "text" : "primary care office visit"
      },
      "cost" : [{
        "type" : {
          "text" : "copay"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "in-network"
          }],
          "text" : "preferred"
        },
        "value" : {
          "value" : 25,
          "unit" : "USD"
        }
      },
      {
        "type" : {
          "text" : "coinsurance"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "in-network"
          }],
          "text" : "participating"
        },
        "value" : {
          "value" : 35,
          "unit" : "%"
        }
      },
      {
        "type" : {
          "text" : "coinsurance"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "out-of-network"
          }],
          "text" : "non-participating"
        },
        "value" : {
          "value" : 35,
          "unit" : "%"
        }
      }]
    },
    {
      "type" : {
        "text" : "specialty care office visit"
      },
      "cost" : [{
        "type" : {
          "text" : "copay"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "in-network"
          }],
          "text" : "preferred"
        },
        "value" : {
          "value" : 35,
          "unit" : "USD"
        }
      },
      {
        "type" : {
          "text" : "coinsurance"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "in-network"
          }],
          "text" : "participating"
        },
        "value" : {
          "value" : 35,
          "unit" : "%"
        }
      },
      {
        "type" : {
          "text" : "coinsurance"
        },
        "applicability" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/applicability",
            "code" : "out-of-network"
          }],
          "text" : "non-participating"
        },
        "value" : {
          "value" : 35,
          "unit" : "%"
        }
      }]
    }]
  }]
}