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
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix sct: <http://snomed.info/id/> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:InsurancePlan ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "example-01"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; ( fhir:profile [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"^^xsd:anyURI ; fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: InsurancePlan example-01</b></p><a name=\"example-01\"> </a><a name=\"hcexample-01\"> </a><a name=\"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\">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:{http://snomed.info/sct 277011002}\">Pre-existing disease in renal transplant</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:\">Specified disease</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=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><p><b>administeredBy</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</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>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "POI" ] ; fhir:display [ fhir:v "Proof of identity" ] ] ) ] ] [ fhir:url [ fhir:v "code"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code"^^xsd:anyURI ] ; fhir:code [ fhir:v "ADN" ] ; fhir:display [ fhir:v "Adhaar number" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "POA" ] ; fhir:display [ fhir:v "Proof of address" ] ] ) ] ] [ fhir:url [ fhir:v "code"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ; fhir:code [ fhir:v "PPN" ] ; fhir:display [ fhir:v "Passport number" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:277011002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "277011002" ] ; fhir:display [ fhir:v "Pre-existing disease in renal transplant" ] ] ) ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "category"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; fhir:text [ fhir:v "Specified disease" ] ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "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." ] ] [ fhir:url [ fhir:v "item"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:86077009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "86077009" ] ; fhir:display [ fhir:v "Operation for glaucoma" ] ] ) ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"^^xsd:anyURI ] ] ) ; # fhir:identifier ( [ fhir:system [ fhir:v "https://irdai.gov.in"^^xsd:anyURI ] ; fhir:value [ fhir:v "761234556546" ] ] ) ; # fhir:status [ fhir:v "active"] ; # fhir:type ( [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Hospitalisation Indemnity Policy" ] ] ) ] ) ; # fhir:name [ fhir:v "Active Assure Silver"] ; # fhir:period [ fhir:start [ fhir:v "2023-09-10"^^xsd:date ] ; fhir:end [ fhir:v "2024-09-10"^^xsd:date ] ] ; # fhir:ownedBy [ fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:administeredBy [ fhir:reference [ fhir:v "Organization/example-02" ] ] ; # fhir:coverage ( [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:737481003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737481003" ] ; fhir:display [ fhir:v "Inpatient care management (procedure)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ] [ fhir:type [ ( fhir:coding [ a sct:87612001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "87612001" ] ; fhir:display [ fhir:v "Blood" ] ] ) ] ] [ fhir:type [ ( fhir:coding [ a sct:24099007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "24099007" ] ; fhir:display [ fhir:v "Oxygen (substance)" ] ] ) ] ] ) ] [ fhir:type [ ( fhir:coding [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Medical Expenses incurred up to 90 days after discharge from the hospital" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:710967003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "710967003" ] ; fhir:display [ fhir:v "Management of health status after discharge from hospital (procedure)" ] ] ) ] ; ( fhir:limit [ fhir:value [ fhir:value [ fhir:v "90"^^xsd:decimal ] ; fhir:comparator [ fhir:v "<=" ] ; fhir:unit [ fhir:v "day" ] ] ] ) ] ) ] [ fhir:type [ ( fhir:coding [ a sct:409972000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "409972000" ] ; fhir:display [ fhir:v "Pre-hospital care (situation)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:409972000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "409972000" ] ; fhir:display [ fhir:v "Pre-hospital care (situation)" ] ] ) ] ; ( fhir:limit [ fhir:value [ fhir:value [ fhir:v "60"^^xsd:decimal ] ; fhir:comparator [ fhir:v "<=" ] ; fhir:unit [ fhir:v "day" ] ] ] ) ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "Per policy limits is up to 10% of the Sum Insured." ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "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" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:737850002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737850002" ] ; fhir:display [ fhir:v "Day care case management" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:737850002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "737850002" ] ; fhir:display [ fhir:v "Day care case management" ] ] ) ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person" ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:105461009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "105461009" ] ; fhir:display [ fhir:v "Organ donor" ] ] ) ] ; ( fhir:benefit [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "claim-condition"^^xsd:anyURI ] ; fhir:value [ a fhir:string ; fhir:v "This coverage is subject to a limit of 10% of the Sum Insured or Rupees One Lakh whichever is less." ] ] ) ; fhir:url [ fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"^^xsd:anyURI ] ] ) ; fhir:type [ ( fhir:coding [ a sct:105461009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "105461009" ] ; fhir:display [ fhir:v "Organ donor" ] ] ) ] ] ) ] ) ; # fhir:plan ( [ ( fhir:identifier [ fhir:use [ fhir:v "official" ] ; fhir:value [ fhir:v "Active Assure Silver" ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Individual" ] ] ) ] ; ( fhir:generalCost [ fhir:cost [ fhir:value [ fhir:v "200000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; ( fhir:specificCost [ fhir:category [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "4000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "20000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] ) ] [ ( fhir:identifier [ fhir:use [ fhir:v "official" ] ; fhir:value [ fhir:v "Active Assure Silver" ] ] ) ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "01" ] ; fhir:display [ fhir:v "Individual" ] ] ) ] ; ( fhir:generalCost [ fhir:cost [ fhir:value [ fhir:v "700000"^^xsd:decimal ] ; fhir:currency [ fhir:v "INR" ] ] ] ) ; ( fhir:specificCost [ fhir:category [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:49122002 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "49122002" ] ; fhir:display [ fhir:v "Ambulance, device (physical object)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "2000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:224663004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "224663004" ] ; fhir:display [ fhir:v "Single room (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "7000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:309904001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "309904001" ] ; fhir:display [ fhir:v "Intensive care unit (environment)" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "14000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] [ fhir:category [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:benefit [ fhir:type [ ( fhir:coding [ a sct:60689008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "60689008" ] ; fhir:display [ fhir:v "Home care of patient" ] ] ) ] ; ( fhir:cost [ fhir:type [ ( fhir:coding [ fhir:code [ fhir:v "fullcoverage" ] ] ) ] ; fhir:value [ fhir:value [ fhir:v "70000"^^xsd:decimal ] ; fhir:unit [ fhir:v "INR" ] ] ] ) ] ) ] ) ] ) . #
IG © 2024+ National Resource Center for EHR Standards. Package ndhm.in#6.5.0 based on FHIR 4.0.1. Generated 2025-05-08
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