FHIR Implementation Guide for ABDM
5.0.0 - active
India
FHIR Implementation Guide for ABDM
5.0.0 - active
India
FHIR Implementation Guide for ABDM - Local Development build (v5.0.0). See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "InsurancePlanBundle-example-01",
"meta" : {
"versionId" : "1",
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlanBundle"
],
"security" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code" : "V",
"display" : "very restricted"
}
]
},
"type" : "collection",
"timestamp" : "2023-09-11T15:32:26.605+05:30",
"entry" : [
{
"fullUrl" : "InsurancePlan/InsurancePlan-example-01",
"resource" : {
"resourceType" : "InsurancePlan",
"id" : "example-01",
"meta" : {
"versionId" : "1",
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"
]
},
"text" : {
"status" : "extensions",
"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:\u00a0761234556546</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:\u00a0Active Assure Silver\u00a0(use:\u00a0OFFICIAL)</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:\u00a0Active Assure Silver\u00a0(use:\u00a0OFFICIAL)</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>"
},
"extension" : [
{
"extension" : [
{
"url" : "category",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code" : "POI",
"display" : "Proof of identity"
}
]
}
},
{
"url" : "code",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ADN",
"display" : "Adhaar number"
}
]
}
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"
},
{
"extension" : [
{
"url" : "category",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code" : "POA",
"display" : "Proof of address"
}
]
}
},
{
"url" : "code",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PPN",
"display" : "Passport number"
}
]
}
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"
},
{
"extension" : [
{
"url" : "category",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "277011002",
"display" : "Pre-existing disease in renal transplant"
}
]
}
},
{
"url" : "statement",
"valueString" : "Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"
},
{
"extension" : [
{
"url" : "category",
"valueCodeableConcept" : {
"text" : "Specified disease"
}
},
{
"url" : "statement",
"valueString" : "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",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "86077009",
"display" : "Operation for glaucoma"
}
]
}
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"
}
],
"identifier" : [
{
"system" : "https://irdai.gov.in",
"value" : "761234556546"
}
],
"status" : "active",
"type" : [
{
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type",
"code" : "01",
"display" : "Hospitalisation Indemnity Policy"
}
]
}
],
"name" : "Active Assure Silver",
"period" : {
"start" : "2023-09-10",
"end" : "2024-09-10"
},
"ownedBy" : {
"reference" : "Organization/example-02"
},
"administeredBy" : {
"reference" : "Organization/example-02"
},
"coverage" : [
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "737481003",
"display" : "Inpatient care management (procedure)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit (environment)"
}
]
}
},
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "87612001",
"display" : "Blood"
}
]
}
},
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "24099007",
"display" : "Oxygen (substance)"
}
]
}
}
]
},
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "710967003",
"display" : "Management of health status after discharge from hospital (procedure)"
}
]
},
"benefit" : [
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "Medical Expenses incurred up to 90 days after discharge from the hospital"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "710967003",
"display" : "Management of health status after discharge from hospital (procedure)"
}
]
},
"limit" : [
{
"value" : {
"value" : 90,
"comparator" : "<=",
"unit" : "day"
}
}
]
}
]
},
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "409972000",
"display" : "Pre-hospital care (situation)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "409972000",
"display" : "Pre-hospital care (situation)"
}
]
},
"limit" : [
{
"value" : {
"value" : 60,
"comparator" : "<=",
"unit" : "day"
}
}
]
}
]
},
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
},
"benefit" : [
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "Per policy limits is up to 10% of the Sum Insured."
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
}
}
]
},
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "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"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "737850002",
"display" : "Day care case management"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "737850002",
"display" : "Day care case management"
}
]
}
}
]
},
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person"
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "105461009",
"display" : "Organ donor"
}
]
},
"benefit" : [
{
"extension" : [
{
"extension" : [
{
"url" : "claim-condition",
"valueString" : "This coverage is subject to a limit of 10% of the Sum Insured or Rupees One Lakh whichever is less."
}
],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "105461009",
"display" : "Organ donor"
}
]
}
}
]
}
],
"plan" : [
{
"identifier" : [
{
"use" : "official",
"value" : "Active Assure Silver"
}
],
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type",
"code" : "01",
"display" : "Individual"
}
]
},
"generalCost" : [
{
"cost" : {
"value" : 200000,
"currency" : "INR"
}
}
],
"specificCost" : [
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 2000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "224663004",
"display" : "Single room (environment)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "224663004",
"display" : "Single room (environment)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 2000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit (environment)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit (environment)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 4000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "60689008",
"display" : "Home care of patient"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "60689008",
"display" : "Home care of patient"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 20000,
"unit" : "INR"
}
}
]
}
]
}
]
},
{
"identifier" : [
{
"use" : "official",
"value" : "Active Assure Silver"
}
],
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type",
"code" : "01",
"display" : "Individual"
}
]
},
"generalCost" : [
{
"cost" : {
"value" : 700000,
"currency" : "INR"
}
}
],
"specificCost" : [
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "49122002",
"display" : "Ambulance, device (physical object)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 2000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "224663004",
"display" : "Single room (environment)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "224663004",
"display" : "Single room (environment)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 7000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit (environment)"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "309904001",
"display" : "Intensive care unit (environment)"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 14000,
"unit" : "INR"
}
}
]
}
]
},
{
"category" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "60689008",
"display" : "Home care of patient"
}
]
},
"benefit" : [
{
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "60689008",
"display" : "Home care of patient"
}
]
},
"cost" : [
{
"type" : {
"coding" : [
{
"code" : "fullcoverage"
}
]
},
"value" : {
"value" : 70000,
"unit" : "INR"
}
}
]
}
]
}
]
}
]
}
},
{
"fullUrl" : "Organization/Organization-example-01",
"resource" : {
"resourceType" : "Organization",
"id" : "Organization-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"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>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PRN",
"display" : "Provider number"
}
]
},
"system" : "https://facility.ndhm.gov.in",
"value" : "4567878"
}
],
"name" : "XYZ insurance pvt. ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1234",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@labs.xyz.org",
"use" : "work"
}
]
}
}
]
}
IG © 2020+ National Resource Center for EHR Standards. Package ndhm.in#5.0.0 based on FHIR 4.0.1. Generated 2023-12-22
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