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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<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 (use: official, )</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 (use: official, )</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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<extension url="code">
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<coding>
<system
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<code value="ADN"/>
<display value="Adhaar number"/>
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<system
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<extension
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<extension url="category">
<valueCodeableConcept>
<coding>
<system
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<extension url="claim-condition">
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<coding>
<system value="http://snomed.info/sct"/>
<code value="87612001"/>
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<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="24099007"/>
<display value="Oxygen (substance)"/>
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<coverage>
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<coding>
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<code value="710967003"/>
<display
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<benefit>
<extension
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<extension url="claim-condition">
<valueString
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<coding>
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<display
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<limit>
<value>
<value value="90"/>
<comparator value="<="/>
<unit value="day"/>
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<coverage>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="409972000"/>
<display value="Pre-hospital care (situation)"/>
</coding>
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<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="409972000"/>
<display value="Pre-hospital care (situation)"/>
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</type>
<limit>
<value>
<value value="60"/>
<comparator value="<="/>
<unit value="day"/>
</value>
</limit>
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<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
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<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
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</type>
<benefit>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
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</extension>
</extension>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
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<coverage>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
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<type>
<coding>
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<type>
<coding>
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<coverage>
<extension
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<extension url="claim-condition">
<valueString
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<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="105461009"/>
<display value="Organ donor"/>
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<benefit>
<extension
url="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition">
<extension url="claim-condition">
<valueString
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<type>
<coding>
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<code value="105461009"/>
<display value="Organ donor"/>
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<plan>
<identifier>
<use value="official"/>
<value value="Active Assure Silver"/>
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<type>
<coding>
<system
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<code value="01"/>
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<generalCost>
<cost>
<value value="200000"/>
<currency value="INR"/>
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<specificCost>
<category>
<coding>
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<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
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<coding>
<system value="http://snomed.info/sct"/>
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<cost>
<type>
<coding>
<code value="fullcoverage"/>
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<unit value="INR"/>
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<specificCost>
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<coding>
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<code value="224663004"/>
<display value="Single room (environment)"/>
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<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
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<type>
<coding>
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<value value="2000"/>
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<coding>
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<plan>
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<value value="Active Assure Silver"/>
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value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"/>
<code value="01"/>
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<cost>
<value value="700000"/>
<currency value="INR"/>
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<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
</coding>
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<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="49122002"/>
<display value="Ambulance, device (physical object)"/>
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<value>
<value value="2000"/>
<unit value="INR"/>
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</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="224663004"/>
<display value="Single room (environment)"/>
</coding>
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<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
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<value>
<value value="7000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</category>
<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="309904001"/>
<display value="Intensive care unit (environment)"/>
</coding>
</type>
<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="14000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
<specificCost>
<category>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
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<benefit>
<type>
<coding>
<system value="http://snomed.info/sct"/>
<code value="60689008"/>
<display value="Home care of patient"/>
</coding>
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<cost>
<type>
<coding>
<code value="fullcoverage"/>
</coding>
</type>
<value>
<value value="70000"/>
<unit value="INR"/>
</value>
</cost>
</benefit>
</specificCost>
</plan>
</InsurancePlan>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:ef131456-dc56-4d73-9e88-87d6cb12091e"/>
<resource>
<Organization>
<id value="ef131456-dc56-4d73-9e88-87d6cb12091e"/>
<meta>
<profile
value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_ef131456-dc56-4d73-9e88-87d6cb12091e"> </a><p class="res-header-id"><b>Generated Narrative: Organization ef131456-dc56-4d73-9e88-87d6cb12091e</b></p><a name="ef131456-dc56-4d73-9e88-87d6cb12091e"> </a><a name="hcef131456-dc56-4d73-9e88-87d6cb12091e"> </a><a name="ef131456-dc56-4d73-9e88-87d6cb12091e-hi-IN"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/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>
</text>
<identifier>
<type>
<coding>
<system
value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code"/>
<code value="ROHINI"/>
<display
value="Registry of Hospitals in Network of Insurance (ROHINI) ID"/>
</coding>
</type>
<system value="https://rohini.iib.gov.in/"/>
<value value="4567878"/>
</identifier>
<name value="XYZ insurance pvt. ltd."/>
<telecom>
<system value="phone"/>
<value value="+91 243 2634 1234"/>
<use value="work"/>
</telecom>
<telecom>
<system value="email"/>
<value value="contact@labs.xyz.org"/>
<use value="work"/>
</telecom>
</Organization>
</resource>
</entry>
</Bundle>