FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v4.0.0). See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix sct: <http://snomed.info/id/> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:Bundle ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "InsurancePlanBundle-example-01"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; ( fhir:profile [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlanBundle"^^xsd:anyURI ; fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlanBundle> ] ) ; ( fhir:security [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-Confidentiality"^^xsd:anyURI ] ; fhir:code [ fhir:v "V" ] ; fhir:display [ fhir:v "very restricted" ] ] ) ] ; # fhir:type [ fhir:v "collection"] ; # fhir:timestamp [ fhir:v "2023-09-11T15:32:26.605+05:30"^^xsd:dateTime] ; # fhir:entry ( [ fhir:fullUrl [ fhir:v "InsurancePlan/InsurancePlan-example-01"^^xsd:anyURI ] ; ( fhir:resource <InsurancePlan/InsurancePlan-example-01> ) ] [ fhir:fullUrl [ fhir:v "Organization/Organization-example-01"^^xsd:anyURI ] ; ( fhir:resource <Organization/Organization-example-01> ) ] ) . # <InsurancePlan/InsurancePlan-example-01> a fhir:InsurancePlan ; fhir:id [ fhir:v "example-01"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; ( fhir:profile [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"^^xsd:anyURI ; fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: InsurancePlan</b><a name=\"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 InsurancePlan "example-01" Version "1" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-InsurancePlan.html\">InsurancePlan</a></p></div><blockquote><p><b>ClaimSupportingInfoRequirement</b></p><blockquote><p><b>url</b></p><code>category</code></blockquote><p><b>value</b>: Proof of identity <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-supportinginfo-category.html\">SupportingInfo Category</a>#POI)</span></p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></blockquote><p><b>value</b>: Adhaar number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-identifier-type-code.html\">Identifier Type Code</a>#ADN)</span></p></blockquote><blockquote><p><b>ClaimSupportingInfoRequirement</b></p><blockquote><p><b>url</b></p><code>category</code></blockquote><p><b>value</b>: Proof of address <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-supportinginfo-category.html\">SupportingInfo Category</a>#POA)</span></p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></blockquote><p><b>value</b>: Passport number <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v2-0203.html\">identifierType</a>#PPN)</span></p></blockquote><blockquote><p><b>ClaimExclusion</b></p><blockquote><p><b>url</b></p><code>category</code></blockquote><p><b>value</b>: Pre-existing disease in renal transplant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#277011002)</span></p><blockquote><p><b>url</b></p><code>statement</code></blockquote><p><b>value</b>: Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months</p></blockquote><blockquote><p><b>ClaimExclusion</b></p><blockquote><p><b>url</b></p><code>category</code></blockquote><p><b>value</b>: Specified disease <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><blockquote><p><b>url</b></p><code>statement</code></blockquote><p><b>value</b>: Expenses related to the treatment of a listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with us.</p><blockquote><p><b>url</b></p><code>item</code></blockquote><p><b>value</b>: Operation for glaucoma <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#86077009)</span></p></blockquote><p><b>identifier</b>: id: 761234556546</p><p><b>status</b>: active</p><p><b>type</b>: Hospitalisation Indemnity Policy <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-insuranceplan-type.html\">InsurancePlan Type</a>#01)</span></p><p><b>name</b>: Active Assure Silver</p><p><b>period</b>: 2023-09-10 --> 2024-09-10</p><p><b>ownedBy</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><p><b>administeredBy</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> "XYZ Insurance Co. Ltd."</p><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><blockquote><p><b>url</b></p><code>claim-condition</code></blockquote><p><b>value</b>: The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner</p></blockquote><p><b>type</b>: Inpatient care management (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#737481003)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Intensive care unit (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Blood <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#87612001)</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Oxygen (substance) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#24099007)</span></p></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Management of health status after discharge from hospital (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#710967003)</span></p><blockquote><p><b>benefit</b></p><blockquote><p><b>ClaimCondition</b></p><blockquote><p><b>url</b></p><code>claim-condition</code></blockquote><p><b>value</b>: Medical Expenses incurred up to 90 days after discharge from the hospital</p></blockquote><p><b>type</b>: Management of health status after discharge from hospital (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#710967003)</span></p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><=90 day</td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: Pre-hospital care (situation) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#409972000)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Pre-hospital care (situation) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#409972000)</span></p><h3>Limits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td><=60 day</td></tr></table></blockquote></blockquote><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><blockquote><p><b>url</b></p><code>claim-condition</code></blockquote><p><b>value</b>: We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur</p></blockquote><p><b>type</b>: Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><blockquote><p><b>url</b></p><code>claim-condition</code></blockquote><p><b>value</b>: The Medical Expenses are incurred, including for any procedure which requires a period of specialized observation or care after completion of the procedure undertaken by an Insured Person as Day Care Treatment</p></blockquote><p><b>type</b>: Day care case management <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#737850002)</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>Day care case management <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#737850002)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><blockquote><p><b>url</b></p><code>claim-condition</code></blockquote><p><b>value</b>: The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person</p></blockquote><p><b>type</b>: Organ donor <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#105461009)</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>Organ donor <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#105461009)</span></td></tr></table></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: id: Active Assure Silver (use: OFFICIAL)</p><p><b>type</b>: Individual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-plan-type.html\">Plan Type</a>#01)</span></p><blockquote><p><b>generalCost</b></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Single room (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#224663004)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Single room (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#224663004)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Intensive care unit (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Intensive care unit (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>4000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Home care of patient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#60689008)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Home care of patient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#60689008)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>20000 INR</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: id: Active Assure Silver (use: OFFICIAL)</p><p><b>type</b>: Individual <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-ndhm-plan-type.html\">Plan Type</a>#01)</span></p><blockquote><p><b>generalCost</b></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>700000</td><td>INR</td></tr></table></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Ambulance, device (physical object) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#49122002)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Single room (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#224663004)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Single room (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#224663004)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>7000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Intensive care unit (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Intensive care unit (environment) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#309904001)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>14000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: Home care of patient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#60689008)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Home care of patient <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#60689008)</span></p><h3>Costs</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td></tr><tr><td style=\"display: none\">*</td><td>fullcoverage <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ([not stated]#fullcoverage)</span></td><td>70000 INR</td></tr></table></blockquote></blockquote></blockquote></div>" ] ; # fhir:extension ( [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "POI" ] ; fhir:display [ fhir:v "Proof of identity" ] ] ) ] ] [ fhir:url [ fhir:v "code"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code"^^xsd:anyURI ] ; fhir:code [ fhir:v "ADN" ] ; fhir:display [ fhir:v "Adhaar number" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "POA" ] ; fhir:display [ fhir:v "Proof of address" ] ] ) ] ] [ fhir:url [ fhir:v "code"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PPN" ] ; fhir:display [ fhir:v "Passport number" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:277011002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "277011002" ] ; fhir:display [ fhir:v "Pre-existing disease in renal transplant" ] ] ) ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; fhir:text [ fhir:v "Specified disease" ] ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "Expenses related to the treatment of a listed conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with us." ] ] [ fhir:url [ fhir:v "item"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:86077009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "86077009" ] ; fhir:display [ fhir:v "Operation for glaucoma" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"^^xsd:anyURI ] ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "https://irdai.gov.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "761234556546" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Hospitalisation Indemnity Policy" ] ] ) ] ) ; # fhir:name [ fhir:v "Active Assure Silver"] ; # fhir:period [ fhir:start [ fhir:v "2023-09-10"^^xsd:date ] ; fhir:end [ fhir:v "2024-09-10"^^xsd:date ] ] ; # fhir:ownedBy [ fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:administeredBy [ fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:coverage ( [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:737481003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737481003" ] ; fhir:display [ fhir:v "Inpatient care management (procedure)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ] [ fhir:type [ ( fhir:coding [ a sct:87612001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "87612001" ] ; fhir:display [ fhir:v "Blood" ] ] ) ] ] [ fhir:type [ ( fhir:coding [ a sct:24099007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "24099007" ] ; fhir:display [ fhir:v "Oxygen (substance)" ] ] ) ] ] ) ] [ fhir:type [ ( fhir:coding [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "Medical Expenses incurred up to 90 days after discharge from the hospital" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; ( fhir:limit [ fhir:value [ fhir:value [ fhir:v "90"^^xsd:decimal ] ; fhir:comparator [ fhir:v "<=" ] ; fhir:unit [ fhir:v "day" ] ] ] ) ] ) ] [ fhir:type [ ( fhir:coding [ a sct:409972000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "409972000" ] ; fhir:display [ fhir:v "Pre-hospital care (situation)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:409972000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "409972000" ] ; fhir:display [ fhir:v "Pre-hospital care (situation)" ] ] ) ] ; ( fhir:limit [ fhir:value [ fhir:value [ fhir:v "60"^^xsd:decimal ] ; fhir:comparator [ fhir:v "<=" ] ; fhir:unit [ fhir:v "day" ] ] ] ) ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "Per policy limits is up to 10% of the Sum Insured." ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "The Medical Expenses are incurred, including for any procedure which requires a period of specialized observation or care after completion of the procedure undertaken by an Insured Person as Day Care Treatment" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:737850002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737850002" ] ; fhir:display [ fhir:v "Day care case management" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:737850002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737850002" ] ; fhir:display [ fhir:v "Day care case management" ] ] ) ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:105461009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "105461009" ] ; fhir:display [ fhir:v "Organ donor" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ fhir:v "This coverage is subject to a limit of 10% of the Sum Insured or Rupees One Lakh whichever is less." ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:105461009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "105461009" ] ; fhir:display [ fhir:v "Organ donor" ] ] ) ] ] ) ] ) ; # fhir:plan ( [ ( fhir:identifier [ fhir:use [ fhir:v "official" ] ; fhir:value [ fhir:v "Active Assure Silver" ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Individual" ] ] ) ] ; ( fhir:generalCost [ fhir:cost [ fhir:value [ fhir:v "200000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; ( fhir:specificCost [ fhir:category [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "4000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "20000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] ) ] [ ( fhir:identifier [ fhir:use [ fhir:v "official" ] ; fhir:value [ fhir:v "Active Assure Silver" ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Individual" ] ] ) ] ; ( fhir:generalCost [ fhir:cost [ fhir:value [ fhir:v "700000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; ( fhir:specificCost [ fhir:category [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "7000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "14000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "70000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] ) ] ) . # <Organization/Organization-example-01> a fhir:Organization ; fhir:id [ fhir:v "Organization-example-01"] ; # fhir:meta [ ( fhir:profile [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"^^xsd:anyURI ; fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"Organization-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 Organization "Organization-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Organization.html\">Organization</a></p></div><p><b>identifier</b>: Provider number: 4567878</p><p><b>name</b>: XYZ insurance pvt. ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@labs.xyz.org\">contact@labs.xyz.org</a></p></div>" ] ; # fhir:identifier ( [ fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PRN" ] ; fhir:display [ fhir:v "Provider number" ] ] ) ] ; fhir:system [ fhir:v "https://facility.ndhm.gov.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "4567878" ] ] ) ; # fhir:name [ fhir:v "XYZ insurance pvt. ltd."] ; # fhir:telecom ( [ fhir:system [ fhir:v "phone" ] ; fhir:value [ fhir:v "+91 243 2634 1234" ] ; fhir:use [ fhir:v "work" ] ] [ fhir:system [ fhir:v "email" ] ; fhir:value [ fhir:v "contact@labs.xyz.org" ] ; fhir:use [ fhir:v "work" ] ] ) . #
IG © 2020+ National Resource Center for EHR Standards. Package ndhm.in#4.0.0 based on FHIR 4.0.1. Generated 2023-11-06
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