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 - XML Representation

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<CoverageEligibilityResponse xmlns="http://hl7.org/fhir">
  <id value="benefits-example-01"/>
  <meta>
    <profile
             value="https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <status value="active"/>
  <purpose value="benefits"/>
  <patient>🔗 
    <reference value="Patient/example-01"/>
  </patient>
  <created value="2023-09-07"/>
  <requestor>🔗 
    <reference value="Practitioner/example-01"/>
  </requestor>
  <request>🔗 
    <reference value="CoverageEligibilityRequest/benefits-example-01"/>
  </request>
  <outcome value="complete"/>
  <disposition value="Policy is currently in-force."/>
  <insurer>🔗 
    <reference value="Organization/example-02"/>
  </insurer>
  <insurance>
    <coverage>🔗 
      <reference value="Coverage/example-01"/>
    </coverage>
    <inforce value="true"/>
    <benefitPeriod>
      <start value="2023-09-07"/>
      <end value="2026-08-07"/>
    </benefitPeriod>
    <item>
      <productOrService>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="768839008"/>
          <display value="Consultant"/>
        </coding>
      </productOrService>
      <benefit>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
            <code value="benefit"/>
            <display value="Benefit"/>
          </coding>
        </type>
        <allowedMoney>
          <value value="50000"/>
          <currency value="INR"/>
        </allowedMoney>
        <usedMoney>
          <value value="0"/>
          <currency value="INR"/>
        </usedMoney>
      </benefit>
    </item>
    <item>
      <productOrService>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="765507008"/>
          <display
                   value="Metformin hydrochloride 500 mg prolonged-release oral tablet"/>
        </coding>
      </productOrService>
      <benefit>
        <type>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/benefit-type"/>
            <code value="benefit"/>
            <display value="Benefit"/>
          </coding>
        </type>
        <allowedMoney>
          <value value="50000"/>
          <currency value="INR"/>
        </allowedMoney>
        <usedMoney>
          <value value="0"/>
          <currency value="INR"/>
        </usedMoney>
      </benefit>
    </item>
  </insurance>
</CoverageEligibilityResponse>