Invoice for medical services covered by insurance

How to generate the correct XML if the invoice contains medical services that are covered by insurer and subject to VAT?

For example, the total value of the service is 100 SAR and the insurer will cover 80 SAR plus VAT so the patient will pay 20 SAR plus VAT.

The patient is Saudi and is exempted from VAT on some medical services.

For the cases where the patient is covered by insurance company and bear a certain percentage of the value:
The Hospital to issue a simplified invoice only for the amount received from the individual patients, and to issue the tax invoice for the rest of value to the insurance company without any change in the current format agreed with them.