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 - XML Representation

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<CoverageEligibilityResponse xmlns="http://hl7.org/fhir">
  <id value="benefit-example-01"/>
  <meta>
    <profile
             value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <status value="active"/>
  <purpose value="validation"/>
  <purpose value="benefits"/>
  <patient>
    <reference value="Patient/example-01"/>
  </patient>
  <servicedDate value="2023-08-07"/>
  <created value="2022-08-07"/>
  <requestor>
    <reference value="Practitioner/example-01"/>
  </requestor>
  <request>
    <reference value="CoverageEligibilityRequest/benefit-example-01"/>
  </request>
  <outcome value="queued"/>
  <disposition value="Policy is currently in-force."/>
  <insurer>
    <reference value="Organization/example-01"/>
  </insurer>
  <insurance id="21233">
    <coverage>
      <reference value="Coverage/example-01"/>
    </coverage>
    <inforce value="true"/>
    <benefitPeriod>
      <start value="2022-05-07"/>
      <end value="2025-08-07"/>
    </benefitPeriod>
    <item>
      <productOrService>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="10849003"/>
          <display value="Removal of foreign body"/>
        </coding>
      </productOrService>
      <benefit>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
            <code value="benefit"/>
          </coding>
        </type>
        <allowedMoney>
          <value value="150000"/>
          <currency value="INR"/>
        </allowedMoney>
      </benefit>
      <benefit>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
            <code value="copay-maximum"/>
          </coding>
        </type>
        <allowedMoney>
          <value value="200000"/>
          <currency value="INR"/>
        </allowedMoney>
      </benefit>
      <benefit>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
            <code value="copay-percent"/>
          </coding>
        </type>
        <allowedUnsignedInt value="20"/>
      </benefit>
    </item>
  </insurance>
</CoverageEligibilityResponse>