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

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: CoverageEligibilityResponse/benefits-example-01 - JSON Representation

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{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "benefits-example-01",
  "meta" : {
    "profile" : [
      🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse benefits-example-01</b></p><a name=\"benefits-example-01\"> </a><a name=\"hcbenefits-example-01\"> </a><a name=\"benefits-example-01-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\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityResponse.html\">CoverageEligibilityResponse</a></p></div><p><b>status</b>: Active</p><p><b>purpose</b>: Coverage benefits</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)</a></p><p><b>created</b>: 2023-09-07</p><p><b>requestor</b>: <a href=\"Practitioner-example-01.html\">Practitioner Dr. DEF</a></p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-benefits-example-01.html\">CoverageEligibilityRequest: identifier = 7612345; status = active; priority = Normal; purpose = benefits; created = 2023-09-07 11:01:00+0500</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Policy is currently in-force.</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Coverage-example-01.html\">Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --&gt; 2026-03-17</a></p><p><b>inforce</b>: true</p><p><b>benefitPeriod</b>: 2023-09-07 --&gt; 2026-08-07</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 768839008}\">Consultant</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></td><td><span title=\"Indian Rupee\">₹50,000.00</span> (INR)</td><td><span title=\"Indian Rupee\">₹0.00</span> (INR)</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 765507008}\">Metformin hydrochloride 500 mg prolonged-release oral tablet</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></td><td><span title=\"Indian Rupee\">₹50,000.00</span> (INR)</td><td><span title=\"Indian Rupee\">₹0.00</span> (INR)</td></tr></table></blockquote></blockquote></div>"
  },
  "status" : "active",
  "purpose" : [
    "benefits"
  ],
  "patient" : {
    🔗 "reference" : "Patient/example-01"
  },
  "created" : "2023-09-07",
  "requestor" : {
    🔗 "reference" : "Practitioner/example-01"
  },
  "request" : {
    🔗 "reference" : "CoverageEligibilityRequest/benefits-example-01"
  },
  "outcome" : "complete",
  "disposition" : "Policy is currently in-force.",
  "insurer" : {
    🔗 "reference" : "Organization/example-02"
  },
  "insurance" : [
    {
      "coverage" : {
        🔗 "reference" : "Coverage/example-01"
      },
      "inforce" : true,
      "benefitPeriod" : {
        "start" : "2023-09-07",
        "end" : "2026-08-07"
      },
      "item" : [
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "768839008",
                "display" : "Consultant"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "benefit",
                    "display" : "Benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 50000,
                "currency" : "INR"
              },
              "usedMoney" : {
                "value" : 0,
                "currency" : "INR"
              }
            }
          ]
        },
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "765507008",
                "display" : "Metformin hydrochloride 500 mg prolonged-release oral tablet"
              }
            ]
          },
          "benefit" : [
            {
              "type" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/benefit-type",
                    "code" : "benefit",
                    "display" : "Benefit"
                  }
                ]
              },
              "allowedMoney" : {
                "value" : 50000,
                "currency" : "INR"
              },
              "usedMoney" : {
                "value" : 0,
                "currency" : "INR"
              }
            }
          ]
        }
      ]
    }
  ]
}