FHIR Implementation Guide for ABDM
6.0.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Bundle InsurancePlanBundle-example-01 of type collection
Entry 1 - fullUrl = urn:uuid:35d8a525-1878-4342-8ca6-fbaa62245529
Resource InsurancePlan:
Generated Narrative: InsurancePlan
Resource InsurancePlan "35d8a525-1878-4342-8ca6-fbaa62245529" Version "1"
Profile: InsurancePlan
ClaimSupportingInfoRequirement
url
category
value: Proof of identity (SupportingInfo Category#POI)
url
codevalue: Adhaar number (Identifier Type Code#ADN)
ClaimSupportingInfoRequirement
url
category
value: Proof of address (SupportingInfo Category#POA)
url
codevalue: 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:
https://irdai.gov.in
/761234556546status: ACTIVE
type: Hospitalisation Indemnity Policy (InsurancePlan Type#01)
name: Active Assure Silver
period: 2023-09-10 --> 2024-09-10
ownedBy: See above (urn:uuid:f42fe22c-ed56-458f-b1db-8800e005fb59)
administeredBy: See above (urn:uuid:f42fe22c-ed56-458f-b1db-8800e005fb59)
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
Extension Type 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
Extension Type Organ donor (SNOMED CT#105461009) plan
identifier: Active Assure Silver (use: OFFICIAL)
type: Individual (Plan Type#01)
generalCost
Costs
Value Currency 200000 INR specificCost
category: Ambulance, device (physical object) (SNOMED CT#49122002)
benefit
type: Ambulance, device (physical object) (SNOMED CT#49122002)
Costs
Type Value fullcoverage ([not stated]#fullcoverage) 2000 INR specificCost
category: Single room (environment) (SNOMED CT#224663004)
benefit
type: Single room (environment) (SNOMED CT#224663004)
Costs
Type Value 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
Type Value 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
Type Value fullcoverage ([not stated]#fullcoverage) 20000 INR plan
identifier: Active Assure Silver (use: OFFICIAL)
type: Individual (Plan Type#01)
generalCost
Costs
Value Currency 700000 INR specificCost
category: Ambulance, device (physical object) (SNOMED CT#49122002)
benefit
type: Ambulance, device (physical object) (SNOMED CT#49122002)
Costs
Type Value fullcoverage ([not stated]#fullcoverage) 2000 INR specificCost
category: Single room (environment) (SNOMED CT#224663004)
benefit
type: Single room (environment) (SNOMED CT#224663004)
Costs
Type Value 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
Type Value 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
Type Value fullcoverage ([not stated]#fullcoverage) 70000 INR
Entry 2 - fullUrl = urn:uuid:f42fe22c-ed56-458f-b1db-8800e005fb59
Resource Organization:
Generated Narrative: Organization
Resource Organization "f42fe22c-ed56-458f-b1db-8800e005fb59"
Profile: Organization
identifier: Provider number/4567878
name: XYZ insurance pvt. ltd.
Contacts
Telecom +91 243 2634 1234, contact@labs.xyz.org