FHIR Implementation Guide for ABDM
5.0.0 - active India

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FHIR Implementation Guide for ABDM - Local Development build (v5.0.0). See the Directory of published versions

Example Bundle: InsurancePlanBundle-example-01

Bundle InsurancePlanBundle-example-01 of type collection


Entry 1 - fullUrl = InsurancePlan/InsurancePlan-example-01

Resource InsurancePlan:

Generated Narrative: InsurancePlan

Resource InsurancePlan "example-01" Version "1"

Profile: InsurancePlan

ClaimSupportingInfoRequirement

url

category

value: Proof of identity (SupportingInfo Category#POI)

url

code

value: Adhaar number (Identifier Type Code#ADN)

ClaimSupportingInfoRequirement

url

category

value: Proof of address (SupportingInfo Category#POA)

url

code

value: Passport number (identifierType#PPN)

ClaimExclusion

url

category

value: Pre-existing disease in renal transplant (SNOMED CT#277011002)

url

statement

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

ClaimExclusion

url

category

value: Specified disease ()

url

statement

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.

url

item

value: Operation for glaucoma (SNOMED CT#86077009)

identifier: id: 761234556546

status: ACTIVE

type: Hospitalisation Indemnity Policy (InsurancePlan Type#01)

name: Active Assure Silver

period: 2023-09-10 --> 2024-09-10

ownedBy: Organization/example-02 "XYZ Insurance Co. Ltd."

administeredBy: Organization/example-02 "XYZ Insurance Co. Ltd."

coverage

ClaimCondition

url

claim-condition

value: The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner

type: Inpatient care management (procedure) (SNOMED CT#737481003)

benefit

type: Intensive care unit (environment) (SNOMED CT#309904001)

benefit

type: Blood (SNOMED CT#87612001)

benefit

type: Oxygen (substance) (SNOMED CT#24099007)

coverage

type: Management of health status after discharge from hospital (procedure) (SNOMED CT#710967003)

benefit

ClaimCondition

url

claim-condition

value: Medical Expenses incurred up to 90 days after discharge from the hospital

type: Management of health status after discharge from hospital (procedure) (SNOMED CT#710967003)

Limits

-Value
*<=90 day

coverage

type: Pre-hospital care (situation) (SNOMED CT#409972000)

benefit

type: Pre-hospital care (situation) (SNOMED CT#409972000)

Limits

-Value
*<=60 day

coverage

ClaimCondition

url

claim-condition

value: We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur

type: Ambulance, device (physical object) (SNOMED CT#49122002)

Benefits

-ExtensionType
*Ambulance, device (physical object) (SNOMED CT#49122002)

coverage

ClaimCondition

url

claim-condition

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

type: Day care case management (SNOMED CT#737850002)

Benefits

-Type
*Day care case management (SNOMED CT#737850002)

coverage

ClaimCondition

url

claim-condition

value: The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person

type: Organ donor (SNOMED CT#105461009)

Benefits

-ExtensionType
*Organ donor (SNOMED CT#105461009)

plan

identifier: id: Active Assure Silver (use: OFFICIAL)

type: Individual (Plan Type#01)

generalCost

Costs

-ValueCurrency
*200000INR

specificCost

category: Ambulance, device (physical object) (SNOMED CT#49122002)

benefit

type: Ambulance, device (physical object) (SNOMED CT#49122002)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)2000 INR

specificCost

category: Single room (environment) (SNOMED CT#224663004)

benefit

type: Single room (environment) (SNOMED CT#224663004)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)2000 INR

specificCost

category: Intensive care unit (environment) (SNOMED CT#309904001)

benefit

type: Intensive care unit (environment) (SNOMED CT#309904001)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)4000 INR

specificCost

category: Home care of patient (SNOMED CT#60689008)

benefit

type: Home care of patient (SNOMED CT#60689008)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)20000 INR

plan

identifier: id: Active Assure Silver (use: OFFICIAL)

type: Individual (Plan Type#01)

generalCost

Costs

-ValueCurrency
*700000INR

specificCost

category: Ambulance, device (physical object) (SNOMED CT#49122002)

benefit

type: Ambulance, device (physical object) (SNOMED CT#49122002)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)2000 INR

specificCost

category: Single room (environment) (SNOMED CT#224663004)

benefit

type: Single room (environment) (SNOMED CT#224663004)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)7000 INR

specificCost

category: Intensive care unit (environment) (SNOMED CT#309904001)

benefit

type: Intensive care unit (environment) (SNOMED CT#309904001)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)14000 INR

specificCost

category: Home care of patient (SNOMED CT#60689008)

benefit

type: Home care of patient (SNOMED CT#60689008)

Costs

-TypeValue
*fullcoverage ([not stated]#fullcoverage)70000 INR


Entry 2 - fullUrl = Organization/Organization-example-01

Resource Organization:

Generated Narrative: Organization

Resource Organization "Organization-example-01"

Profile: Organization

identifier: Provider number: 4567878

name: XYZ insurance pvt. ltd.

telecom: +91 243 2634 1234, contact@labs.xyz.org