FHIR Implementation Guide for ABDM
6.0.0 - active India flag

Banner

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

: InsurancePlan/example-01 - JSON Representation

Raw json | Download


{
  "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 &quot;example-01&quot; Version &quot;1&quot; </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>: <code>https://irdai.gov.in</code>/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 --&gt; 2024-09-10</p><p><b>ownedBy</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> &quot;XYZ Insurance Co. Ltd.&quot;</p><p><b>administeredBy</b>: <a href=\"Organization-example-02.html\">Organization/example-02</a> &quot;XYZ Insurance Co. Ltd.&quot;</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>&lt;=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>&lt;=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>: Active 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>: Active 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"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}