FHIR Implementation Guide for ABDM - Local Development build (v3.0.0). See the Directory of published versions

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: CoverageEligibilityResponse/benefit-example-01 - JSON Representation

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{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "benefit-example-01",
  "meta" : {
    "profile" : [
      "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name=\"benefit-example-01\"> </a></p><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\">Resource CoverageEligibilityResponse \"benefit-example-01\"  (Language \"en\") </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityResponse.html\">CoverageEligibilityResponse</a></p></div><p><b>status</b>: active</p><p><b>purpose</b>: validation, benefits</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> \"\"</p><p><b>serviced</b>: 2023-08-07</p><p><b>created</b>: 2022-08-07</p><p><b>requestor</b>: <a href=\"Practitioner-example-01.html\">Practitioner/example-01</a> \"\"</p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-benefit-example-01.html\">CoverageEligibilityRequest/benefit-example-01</a></p><p><b>outcome</b>: queued</p><p><b>disposition</b>: Policy is currently in-force.</p><p><b>insurer</b>: <a href=\"Organization-example-01.html\">Organization/example-01</a> \"XYZ Lab Pvt.Ltd.\"</p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Coverage-example-01.html\">Coverage/example-01</a></p><p><b>inforce</b>: true</p><p><b>benefitPeriod</b>: 2022-05-07 --&gt; 2025-08-07</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: Removal of foreign body <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#10849003)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#benefit)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹150,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment maximum per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-maximum)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹200,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment Percent per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-percent)</span></p><p><b>allowed</b>: 20</p></blockquote></blockquote></blockquote></div>"
  },
  "status" : "active",
  "purpose" : [
    "validation",
    "benefits"
  ],
  "patient" : {
    "reference" : "Patient/example-01"
  },
  "servicedDate" : "2023-08-07",
  "created" : "2022-08-07",
  "requestor" : {
    "reference" : "Practitioner/example-01"
  },
  "request" : {
    "reference" : "CoverageEligibilityRequest/benefit-example-01"
  },
  "outcome" : "queued",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    "reference" : "Organization/example-01"
  },
  "insurance" : [
    {
      "id" : "21233",
      "coverage" : {
        "reference" : "Coverage/example-01"
      },
      "inforce" : true,
      "benefitPeriod" : {
        "start" : "2022-05-07",
        "end" : "2025-08-07"
      },
      "item" : [
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "10849003",
                "display" : "Removal of foreign body"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 150000,
                "currency" : "INR"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "copay-maximum"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 200000,
                "currency" : "INR"
              }
            },
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "copay-percent"
                  }
                ]
              },
              "allowedUnsignedInt" : 20
            }
          ]
        }
      ]
    }
  ]
}