FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: 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
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🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlanBundle"
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"timestamp" : "2023-09-11T15:32:26.605+05:30",
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{
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"InsurancePlan_35d8a525-1878-4342-8ca6-fbaa62245529\"> </a><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan 35d8a525-1878-4342-8ca6-fbaa62245529</b></p><a name=\"35d8a525-1878-4342-8ca6-fbaa62245529\"> </a><a name=\"hc35d8a525-1878-4342-8ca6-fbaa62245529\"> </a><a name=\"35d8a525-1878-4342-8ca6-fbaa62245529-hi-IN\"> </a><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\">version: 1</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-InsurancePlan.html\">InsurancePlan</a></p></div><blockquote><p><b>ClaimSupportingInfoRequirement</b></p><ul><li>category: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category POI}\">Proof of identity</span></li><li>code: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code ADN}\">Adhaar number</span></li></ul></blockquote><blockquote><p><b>ClaimSupportingInfoRequirement</b></p><ul><li>category: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category POA}\">Proof of address</span></li><li>code: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0203 PPN}\">Passport number</span></li></ul></blockquote><blockquote><p><b>ClaimExclusion</b></p><ul><li>category: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion Excl01}\">Pre-Existing Diseases</span></li><li>statement: Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months</li></ul></blockquote><blockquote><p><b>ClaimExclusion</b></p><ul><li>category: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion Excl02}\">Specified disease/procedure waiting period</span></li><li>statement: 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.</li><li>item: <span title=\"Codes:{http://snomed.info/sct 86077009}\">Operation for glaucoma</span></li></ul></blockquote><p><b>identifier</b>: <code>https://irdai.gov.in</code>/761234556546</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type 01}\">Hospitalisation Indemnity Policy</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=\"Bundle-InsurancePlanBundle-example-01.html#urn-uuid-ef131456-dc56-4d73-9e88-87d6cb12091e\">Bundle: type = collection; timestamp = 2023-09-11 15:32:26+0530</a></p><p><b>administeredBy</b>: <a href=\"Bundle-InsurancePlanBundle-example-01.html#urn-uuid-ef131456-dc56-4d73-9e88-87d6cb12091e\">Bundle: type = collection; timestamp = 2023-09-11 15:32:26+0530</a></p><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><ul><li>claim-condition: The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner</li></ul></blockquote><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737481003}\">Inpatient care management (procedure)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit (environment)</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 87612001}\">Blood</span></p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 24099007}\">Oxygen (substance)</span></p></blockquote></blockquote><blockquote><p><b>coverage</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 710967003}\">Management of health status after discharge from hospital (procedure)</span></p><blockquote><p><b>benefit</b></p><blockquote><p><b>ClaimCondition</b></p><ul><li>claim-condition: Medical Expenses incurred up to 90 days after discharge from the hospital</li></ul></blockquote><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 710967003}\">Management of health status after discharge from hospital (procedure)</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>: <span title=\"Codes:{http://snomed.info/sct 409972000}\">Pre-hospital care (situation)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 409972000}\">Pre-hospital care (situation)</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><ul><li>claim-condition: We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur</li></ul></blockquote><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</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><span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><ul><li>claim-condition: 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</li></ul></blockquote><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 737850002}\">Day care case management</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><span title=\"Codes:{http://snomed.info/sct 737850002}\">Day care case management</span></td></tr></table></blockquote><blockquote><p><b>coverage</b></p><blockquote><p><b>ClaimCondition</b></p><ul><li>claim-condition: The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person</li></ul></blockquote><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 105461009}\">Organ donor</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><span title=\"Codes:{http://snomed.info/sct 105461009}\">Organ donor</span></td></tr></table></blockquote><blockquote><p><b>plan</b></p><p><b>identifier</b>: Active Assure Silver\u00a0(use:\u00a0official,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type 01}\">Individual</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>Indian rupee</td></tr></table></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</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><span title=\"Codes:\">fullcoverage</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 224663004}\">Single room (environment)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 224663004}\">Single room (environment)</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><span title=\"Codes:\">fullcoverage</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit (environment)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit (environment)</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><span title=\"Codes:\">fullcoverage</span></td><td>4000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 60689008}\">Home care of patient</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 60689008}\">Home care of patient</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><span title=\"Codes:\">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,\u00a0)</p><p><b>type</b>: <span title=\"Codes:{https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type 01}\">Individual</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>Indian rupee</td></tr></table></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 49122002}\">Ambulance, device (physical object)</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><span title=\"Codes:\">fullcoverage</span></td><td>2000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 224663004}\">Single room (environment)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 224663004}\">Single room (environment)</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><span title=\"Codes:\">fullcoverage</span></td><td>7000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit (environment)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 309904001}\">Intensive care unit (environment)</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><span title=\"Codes:\">fullcoverage</span></td><td>14000 INR</td></tr></table></blockquote></blockquote><blockquote><p><b>specificCost</b></p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 60689008}\">Home care of patient</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: <span title=\"Codes:{http://snomed.info/sct 60689008}\">Home care of patient</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><span title=\"Codes:\">fullcoverage</span></td><td>70000 INR</td></tr></table></blockquote></blockquote></blockquote></div>"
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{
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"benefit" : [
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"type" : {
"coding" : [
{
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"code" : "409972000",
"display" : "Pre-hospital care (situation)"
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]
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"limit" : [
{
"value" : {
"value" : 60,
"comparator" : "<=",
"unit" : "day"
}
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{
"extension" : [
{
"extension" : [
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"url" : "claim-condition",
"valueString" : "We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur"
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],
"url" : "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type" : {
"coding" : [
{
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"code" : "49122002",
"display" : "Ambulance, device (physical object)"
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"benefit" : [
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"extension" : [
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"extension" : [
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"type" : {
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"extension" : [
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"type" : {
"coding" : [
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"benefit" : [
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"extension" : [
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