FHIR Implementation Guide for ABDM
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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. For a full list of available versions, see the Directory of published versions

Example CoverageEligibilityResponse: CoverageEligibilityResponse/benefits-example-01

Generated Narrative: CoverageEligibilityResponse benefits-example-01

Language: en

Profile: CoverageEligibilityResponse

status: Active

purpose: Coverage benefits

patient: ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)

created: 2023-09-07

requestor: Practitioner Dr. DEF

request: CoverageEligibilityRequest: identifier = 7612345; status = active; priority = Normal; purpose = benefits; created = 2023-09-07 11:01:00+0500

outcome: Processing Complete

disposition: Policy is currently in-force.

insurer: Organization XYZ Insurance Co. Ltd.

insurance

coverage: Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --> 2026-03-17

inforce: true

benefitPeriod: 2023-09-07 --> 2026-08-07

item

productOrService: Consultant

Benefits

-TypeAllowed[x]Used[x]
*Benefit₹50,000.00 (INR)₹0.00 (INR)

item

productOrService: Metformin hydrochloride 500 mg prolonged-release oral tablet

Benefits

-TypeAllowed[x]Used[x]
*Benefit₹50,000.00 (INR)₹0.00 (INR)