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plan.xsd
executable file
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plan.xsd
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<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XMLSpy v2014 (http://www.altova.com) by Dan Thomas (DC Department of Human Services DCAS Project) -->
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://openhbx.org/api/terms/1.0" targetNamespace="http://openhbx.org/api/terms/1.0" elementFormDefault="qualified">
<xs:include schemaLocation="common.xsd"/>
<xs:include schemaLocation="organization.xsd"/>
<xs:complexType name="PlanType">
<xs:annotation>
<xs:documentation>Individual or group insurance product that provides, or pays the cost of, medical care</xs:documentation>
</xs:annotation>
<xs:sequence>
<xs:group ref="HbxIdentifierGroup"/>
<xs:element name="qhp_id" type="HiosPlanIdType">
<xs:annotation>
<xs:documentation>HIOS Plan Identifier</xs:documentation>
</xs:annotation>
</xs:element>
<xs:element name="name" type="xs:string"/>
<xs:element name="is_dental_only_flag" type="xs:boolean"/>
<xs:element name="carrier" type="CarrierLinkType"/>
<xs:element name="coverage_type" type="BenefitCoverageNameType"/>
<xs:element name="metal_level" type="PlanMetalLevelNameType"/>
<xs:element name="ehb_percent" minOccurs="0">
<xs:annotation>
<xs:documentation>Essential Health Benefit factor</xs:documentation>
</xs:annotation>
</xs:element>
<xs:element name="market" type="HbxMarketNameType" minOccurs="0"/>
<xs:element name="coverages" minOccurs="0">
<xs:complexType>
<xs:sequence>
<xs:element name="coverage" type="CoverageType" maxOccurs="unbounded"/>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name="cost_structure" type="CostStructureType" minOccurs="0"/>
<xs:element name="maximums" minOccurs="0">
<xs:complexType>
<xs:complexContent>
<xs:extension base="MaximumType"/>
</xs:complexContent>
</xs:complexType>
</xs:element>
<xs:element name="deductables" type="DeductableType" minOccurs="0"/>
<xs:element name="metadata" type="xs:string" minOccurs="0"/>
<xs:element name="rates" type="RateType" minOccurs="0"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="PlanLinkType">
<xs:complexContent>
<xs:restriction base="PlanType">
<xs:sequence>
<xs:group ref="HbxIdentifierGroup"/>
<xs:element name="qhp_id" type="HiosPlanIdType">
<xs:annotation>
<xs:documentation>HIOS Plan Identifier</xs:documentation>
</xs:annotation>
</xs:element>
<xs:element name="name" type="xs:string"/>
<xs:element name="is_dental_only_flag" type="xs:boolean"/>
<xs:element name="carrier" type="CarrierLinkType"/>
<xs:element name="coverage_type" type="BenefitCoverageNameType"/>
<xs:element name="metal_level" type="PlanMetalLevelNameType"/>
<xs:element name="ehb_percent" minOccurs="0">
<xs:annotation>
<xs:documentation>Essential Health Benefit factor</xs:documentation>
</xs:annotation>
</xs:element>
</xs:sequence>
</xs:restriction>
</xs:complexContent>
</xs:complexType>
<xs:complexType name="RateType">
<xs:sequence>
<xs:element name="age"/>
<xs:element name="effective_date" type="SimpleDateType"/>
<xs:element name="expire_date" type="SimpleDateType"/>
<xs:element name="rate" type="CurrencyType"/>
<xs:element name="rating_area"/>
<xs:element name="tobacco_use"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="CostStructureType">
<xs:sequence>
<xs:element name="first_tier_utilization" type="xs:int"/>
<xs:element name="issuer_actuarial_value" type="xs:float"/>
<xs:element name="multiple_in_network_tiers" type="xs:boolean"/>
<xs:element name="sbc_scenario">
<xs:complexType>
<xs:sequence>
<xs:element name="having_diabetes"/>
<xs:element name="having_a_baby"/>
</xs:sequence>
</xs:complexType>
</xs:element>
<xs:element name="custom_scenarios" minOccurs="0" maxOccurs="unbounded">
<xs:complexType>
<xs:sequence>
<xs:element name="name">
<xs:complexType>
<xs:sequence>
<xs:element name="networks" type="CostByNetworkType"/>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:sequence>
</xs:complexType>
<xs:complexType name="CoverageType">
<xs:sequence>
<xs:element name="name">
<xs:complexType>
<xs:sequence>
<xs:element name="is_covered_flag" type="xs:boolean"/>
<xs:element name="ehb_variance_reason" type="xs:string" minOccurs="0"/>
<xs:element name="excluded_from_in_network_moop" type="xs:boolean" minOccurs="0"/>
<xs:element name="excluded_from_out_of_network_moop" type="xs:boolean" minOccurs="0"/>
<xs:element name="exclusions" type="xs:string" minOccurs="0"/>
<xs:element name="quantitative_limit" type="xs:boolean" minOccurs="0"/>
<xs:element name="subject_to_deductable_t1" type="xs:boolean" minOccurs="0"/>
<xs:element name="subject_to_deductable_t2" type="xs:boolean" minOccurs="0"/>
<xs:element name="costs" type="CoverageCostType" minOccurs="0"/>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:sequence>
</xs:complexType>
<xs:complexType name="DeductableType">
<xs:sequence>
<xs:element name="name"/>
<xs:element name="networks" type="CostByNetworkType"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="MaximumType">
<xs:sequence>
<xs:element name="name" type="xs:string"/>
<xs:element name="networks" type="CostByNetworkType"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="PlanMetadataType">
<xs:sequence>
<xs:element name="brochure_url" type="xs:anyURI"/>
<xs:element name="child_only_offering" type="xs:string"/>
<xs:element name="disease_management_program_offered" type="xs:string"/>
<xs:element name="formulary_id" type="xs:string"/>
<xs:element name="hios_plan_id" type="xs:string"/>
<xs:element name="hsa_eligible" type="xs:boolean"/>
<xs:element name="limited_cost_sharing_plan_variation_est_adv_payment" type="xs:int"/>
<xs:element name="metalic_level">
<xs:simpleType>
<xs:restriction base="xs:string">
<xs:enumeration value="platinum"/>
<xs:enumeration value="gold"/>
<xs:enumeration value="silver"/>
<xs:enumeration value="bronze"/>
</xs:restriction>
</xs:simpleType>
</xs:element>
<xs:element name="national_network" type="xs:boolean"/>
<xs:element name="network_id" type="xs:string" default='"DCN001"'/>
<xs:element name="new_or_existing_plan">
<xs:simpleType>
<xs:restriction base="xs:string">
<xs:enumeration value="new"/>
<xs:enumeration value="existing"/>
</xs:restriction>
</xs:simpleType>
</xs:element>
<xs:element name="notice_required_for_pregnancy" type="xs:boolean"/>
<xs:element name="out_of_country_coverage" type="xs:boolean"/>
<xs:element name="out_of_service_area_coverage" type="xs:boolean"/>
<xs:element name="out_of_service_area_description" type="xs:string"/>
<xs:element name="plan_effective_date" type="SimpleDateType"/>
<xs:element name="plan_type" type="xs:string"/>
<xs:element name="qhp" type="xs:string"/>
<xs:element name="referral_required_for_specialist" type="xs:boolean"/>
<xs:element name="sbc_url" type="xs:anyURI"/>
<xs:element name="service_area_Id" type="xs:string" default='"DCS001"'/>
<xs:element name="unique_plan_design" type="xs:boolean"/>
<xs:element name="wellness_program_offered" type="xs:boolean"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="CoverageCostType">
<xs:sequence>
<xs:element name="coinsurance" type="CostByNetworkType"/>
<xs:element name="copay" type="CostByNetworkType"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="CostByNetworkType">
<xs:sequence>
<xs:element name="in_network_tier" type="MaxCostByCoverageCategoryType"/>
<xs:element name="out_of_network" type="MaxCostByCoverageCategoryType"/>
<xs:element name="in_network_tier_2" type="MaxCostByCoverageCategoryType" minOccurs="0"/>
<xs:element name="combined_in_out_network" type="MaxCostByCoverageCategoryType" minOccurs="0"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="ProcedureType">
<xs:sequence>
<xs:element name="name" type="xs:string"/>
<xs:element name="costs" type="CostByNetworkType"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="MaxCostByCoverageCategoryType">
<xs:sequence>
<xs:element name="family" type="xs:integer"/>
<xs:element name="individual" type="xs:integer"/>
<xs:element name="default_coinsurance" type="xs:integer"/>
</xs:sequence>
</xs:complexType>
<xs:complexType name="Deductables"/>
<xs:element name="plan">
<xs:annotation>
<xs:documentation>Medical insurance plan instance</xs:documentation>
</xs:annotation>
<xs:complexType>
<xs:complexContent>
<xs:extension base="PlanType"/>
</xs:complexContent>
</xs:complexType>
</xs:element>
<xs:simpleType name="EnrolleeRelationshipNameType">
<xs:annotation>
<xs:documentation>Interpersonal relationship names between individuals in a plan enrollment</xs:documentation>
</xs:annotation>
<xs:restriction base="xs:anyURI">
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#self"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#spouse"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#father"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#mother"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#grandfather"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#grandmother"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#grandson"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#granddaughter"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#uncle"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#aunt"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#nephew"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#niece"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#cousin"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#adopted_child"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#foster_child"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#son_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#daughter_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#brother_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#sister_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#father_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#mother_in_law"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#brother"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#sister"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#ward"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#stepparent"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#stepson"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#stepdaughter"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#child"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#sponsored_dependent"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#dependent_of_a_minor_dependent"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#ex_spouse"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#guardian"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#court_appointed_guardian"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#collateral_dependent"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#life_partner"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#female"/>
<xs:enumeration value="urn:openhbx:terms:v1:enrollee_relationship#unknown"/>
</xs:restriction>
</xs:simpleType>
<xs:simpleType name="BenefitCoverageNameType">
<xs:annotation>
<xs:documentation>Kind of medical insurance provided under plan</xs:documentation>
</xs:annotation>
<xs:restriction base="xs:anyURI">
<xs:enumeration value="urn:openhbx:terms:v1:benefit_coverage#health"/>
<xs:enumeration value="urn:openhbx:terms:v1:benefit_coverage#dental"/>
</xs:restriction>
</xs:simpleType>
<xs:simpleType name="PlanMetalLevelNameType">
<xs:annotation>
<xs:documentation>ACA plan category designation</xs:documentation>
</xs:annotation>
<xs:restriction base="xs:anyURI">
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#bronze"/>
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#silver"/>
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#gold"/>
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#platinum"/>
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#catastrophic"/>
<xs:enumeration value="urn:openhbx:terms:v1:plan_metal_level#dental"/>
</xs:restriction>
</xs:simpleType>
<xs:simpleType name="HiosPlanIdType">
<xs:annotation>
<xs:documentation>Health Insurance Oversight System (HIOS) plan identifier</xs:documentation>
</xs:annotation>
<xs:restriction base="xs:string"/>
</xs:simpleType>
</xs:schema>