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. For a full list of available versions, see the Directory of published versions
Generated Narrative: InsurancePlan example-01
version: 1
Profile: InsurancePlan
ClaimSupportingInfoRequirement
- category: Proof of identity
- code: Adhaar number
ClaimSupportingInfoRequirement
- category: Proof of address
- code: Passport number
ClaimExclusion
- category: Pre-existing disease in renal transplant
- 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
ClaimExclusion
- category: Specified disease
- 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.
- item: Operation for glaucoma
identifier: https://irdai.gov.in/761234556546
status: Active
type: Hospitalisation Indemnity Policy
name: Active Assure Silver
period: 2023-09-10 --> 2024-09-10
ownedBy: Organization XYZ Insurance Co. Ltd.
administeredBy: Organization XYZ Insurance Co. Ltd.
coverage
ClaimCondition
- claim-condition: The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner
type: Inpatient care management (procedure)
benefit
type: Intensive care unit (environment)
benefit
type: Blood
benefit
type: Oxygen (substance)
coverage
type: Management of health status after discharge from hospital (procedure)
benefit
ClaimCondition
- claim-condition: Medical Expenses incurred up to 90 days after discharge from the hospital
type: Management of health status after discharge from hospital (procedure)
Limits
Value <=90 day
coverage
type: Pre-hospital care (situation)
benefit
type: Pre-hospital care (situation)
Limits
Value <=60 day
coverage
ClaimCondition
- claim-condition: We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur
type: Ambulance, device (physical object)
Benefits
Extension Type Ambulance, device (physical object)
coverage
ClaimCondition
- 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
type: Day care case management
Benefits
Type Day care case management
coverage
ClaimCondition
- claim-condition: The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person
type: Organ donor
Benefits
Extension Type Organ donor
plan
identifier: Active Assure Silver (use: official, )
type: Individual
generalCost
Costs
Value Currency 200000 Indian rupee specificCost
category: Ambulance, device (physical object)
benefit
type: Ambulance, device (physical object)
Costs
Type Value fullcoverage 2000 INR specificCost
category: Single room (environment)
benefit
type: Single room (environment)
Costs
Type Value fullcoverage 2000 INR specificCost
category: Intensive care unit (environment)
benefit
type: Intensive care unit (environment)
Costs
Type Value fullcoverage 4000 INR specificCost
category: Home care of patient
benefit
type: Home care of patient
Costs
Type Value fullcoverage 20000 INR
plan
identifier: Active Assure Silver (use: official, )
type: Individual
generalCost
Costs
Value Currency 700000 Indian rupee specificCost
category: Ambulance, device (physical object)
benefit
type: Ambulance, device (physical object)
Costs
Type Value fullcoverage 2000 INR specificCost
category: Single room (environment)
benefit
type: Single room (environment)
Costs
Type Value fullcoverage 7000 INR specificCost
category: Intensive care unit (environment)
benefit
type: Intensive care unit (environment)
Costs
Type Value fullcoverage 14000 INR specificCost
category: Home care of patient
benefit
type: Home care of patient
Costs
Type Value fullcoverage 70000 INR