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
<InsurancePlan xmlns="http://hl7.org/fhir">
<id value="example-01"/>
<meta>
<versionId value="1"/>
<profile
value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"/>
</meta>
<text>
<status value="extensions"/>
<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>
</text>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement">
<extension url="category">
<valueCodeableConcept>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"/>
<code value="POI"/>
<display value="Proof of identity"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="code">
<valueCodeableConcept>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code"/>
<code value="ADN"/>
<display value="Adhaar number"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement">
<extension url="category">
<valueCodeableConcept>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"/>
<code value="POA"/>
<display value="Proof of address"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="code">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="PPN"/>
<display value="Passport number"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion">
<extension url="category">
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="277011002"/>
<display value="Pre-existing disease in renal transplant"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="statement">
<valueString
value="Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months"/>
</extension>
</extension>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion">
<extension url="category">
<valueCodeableConcept>
<text value="Specified disease"/>
</valueCodeableConcept>
</extension>
<extension url="statement">
<valueString
value="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."/>
</extension>
<extension url="item">
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="86077009"/>
<display value="Operation for glaucoma"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<identifier>
<system value="https://irdai.gov.in"/>
<value value="761234556546"/>
</identifier>
<status value="active"/>
<type>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type"/>
<code value="01"/>
<display value="Hospitalisation Indemnity Policy"/>
</coding>
</type>
<name value="Active Assure Silver"/>
<period>
<start value="2023-09-10"/>
<end value="2024-09-10"/>
</period>
<ownedBy>
<reference value="Organization/example-02"/>
</ownedBy>
<administeredBy>
<reference value="Organization/example-02"/>
</administeredBy>
<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner"/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="737481003"/>
<display value="Inpatient care management (procedure)"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</type>
</benefit>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="87612001"/>
<display value="Blood"/>
</coding>
</type>
</benefit>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="24099007"/>
<display value="Oxygen (substance)"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="710967003"/>
<display
value="Management of health status after discharge from hospital (procedure)"/>
</coding>
</type>
<benefit>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="Medical Expenses incurred up to 90 days after discharge from the hospital"/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="710967003"/>
<display
value="Management of health status after discharge from hospital (procedure)"/>
</coding>
</type>
<limit>
<value>
<value value="90"/>
<comparator value="<="/>
<unit value="day"/>
</value>
</limit>
</benefit>
</coverage>
<coverage>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="409972000"/>
<display value="Pre-hospital care (situation)"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="409972000"/>
<display value="Pre-hospital care (situation)"/>
</coding>
</type>
<limit>
<value>
<value value="60"/>
<comparator value="<="/>
<unit value="day"/>
</value>
</limit>
</benefit>
</coverage>
<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur"/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</type>
<benefit>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="Per policy limits is up to 10% of the Sum Insured."/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="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"/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="737850002"/>
<display value="Day care case management"/>
</coding>
</type>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="737850002"/>
<display value="Day care case management"/>
</coding>
</type>
</benefit>
</coverage>
<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person"/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="105461009"/>
<display value="Organ donor"/>
</coding>
</type>
<benefit>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
value="This coverage is subject to a limit of 10% of the Sum Insured or Rupees One Lakh whichever is less."/>
</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="105461009"/>
<display value="Organ donor"/>
</coding>
</type>
</benefit>
</coverage>
<plan>
<identifier>
<use value="official"/>
<value value="Active Assure Silver"/>
</identifier>
<type>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"/>
<code value="01"/>
<display value="Individual"/>
</coding>
</type>
<generalCost>
<cost>
<value value="200000"/>
<currency value="INR"/>
</cost>
</generalCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="2000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="2000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="4000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="20000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
<plan>
<identifier>
<use value="official"/>
<value value="Active Assure Silver"/>
</identifier>
<type>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"/>
<code value="01"/>
<display value="Individual"/>
</coding>
</type>
<generalCost>
<cost>
<value value="700000"/>
<currency value="INR"/>
</cost>
</generalCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="2000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="7000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="14000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="70000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
</InsurancePlan>
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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