Some inclusions are conditional:
No benefits will be provided for:
- Cranial banding, unless otherwise determined by us;
The "unless" prevents an inconsistency if benefits are paid for cranial banding. How to model this?
Without the condition, we get:
Is prolotherapy covered?
It is turned into searching logical state of
Certificate ToCover Prolotherapy.
which is mapped to
Certificate ToProvide Benefits for prolotherapy
and we search in the group, find Prolotherapy and find False state.
When we add "unless otherwise determined by us", we have to duplicate much of the structure, and the "unless" prevents an inconsistency if benefits are paid, when we said they would not be.
The Benefits ToProvideFor has been duplicated, this time allowing for a determination to override the general statement. The "unless" branch can be made true by matching, when it switches off the normal logical path.
The arrangement only works for probing individual cases, otherwise we would need to duplicate the main ToProvideFor for every member of the group.