FHIR IG analytics| Package | ndhm.in |
| Resource Type | InsurancePlan |
| Id | InsurancePlan-example-01.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
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
FHIR
FHIRsmith{
"resourceType": "InsurancePlan",
"id": "example-01",
"meta": {
"versionId": "1",
"profile": [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"extension": [
{
"url": "category",
"valueCodeableConcept": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code": "POI",
"display": "Proof of identity"
}
]
}
},
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code": "ADN",
"display": "Adhaar number"
}
]
}
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"
},
{
"extension": [
{
"url": "category",
"valueCodeableConcept": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-supportinginfo-category",
"code": "POA",
"display": "Proof of address"
}
]
}
},
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PPN",
"display": "Passport number"
}
]
}
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement"
},
{
"extension": [
{
"url": "category",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "277011002",
"display": "Pre-existing disease in renal transplant"
}
]
}
},
{
"url": "statement",
"valueString": "Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded untit the expiry of 48 months"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"
},
{
"extension": [
{
"url": "category",
"valueCodeableConcept": {
"text": "Specified disease"
}
},
{
"url": "statement",
"valueString": "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."
},
{
"url": "item",
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "86077009",
"display": "Operation for glaucoma"
}
]
}
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion"
}
],
"identifier": [
{
"system": "https://irdai.gov.in",
"value": "761234556546"
}
],
"status": "active",
"type": [
{
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-insuranceplan-type",
"code": "01",
"display": "Hospitalisation Indemnity Policy"
}
]
}
],
"name": "Active Assure Silver",
"period": {
"start": "2023-09-10",
"end": "2024-09-10"
},
"ownedBy": {
"reference": "Organization/example-02"
},
"administeredBy": {
"reference": "Organization/example-02"
},
"coverage": [
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "The Hospitalization is medically necessary and follows the written advice of a Medical Practitioner"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737481003",
"display": "Inpatient care management (procedure)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit (environment)"
}
]
}
},
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "87612001",
"display": "Blood"
}
]
}
},
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "24099007",
"display": "Oxygen (substance)"
}
]
}
}
]
},
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "710967003",
"display": "Management of health status after discharge from hospital (procedure)"
}
]
},
"benefit": [
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "Medical Expenses incurred up to 90 days after discharge from the hospital"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "710967003",
"display": "Management of health status after discharge from hospital (procedure)"
}
]
},
"limit": [
{
"value": {
"value": 90,
"comparator": "<=",
"unit": "day"
}
}
]
}
]
},
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "409972000",
"display": "Pre-hospital care (situation)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "409972000",
"display": "Pre-hospital care (situation)"
}
]
},
"limit": [
{
"value": {
"value": 60,
"comparator": "<=",
"unit": "day"
}
}
]
}
]
},
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "We have accepted a claim for In-patient Hospitalization under Section C.I.(a) above for the same Illness/ Injur"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
},
"benefit": [
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "Per policy limits is up to 10% of the Sum Insured."
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
}
}
]
},
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "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"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737850002",
"display": "Day care case management"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "737850002",
"display": "Day care case management"
}
]
}
}
]
},
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "The donation conforms to The Transplantation of Human Organs Act 1994 and the organ is for the use of the Insured Person"
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "105461009",
"display": "Organ donor"
}
]
},
"benefit": [
{
"extension": [
{
"extension": [
{
"url": "claim-condition",
"valueString": "This coverage is subject to a limit of 10% of the Sum Insured or Rupees One Lakh whichever is less."
}
],
"url": "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition"
}
],
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "105461009",
"display": "Organ donor"
}
]
}
}
]
}
],
"plan": [
{
"identifier": [
{
"use": "official",
"value": "Active Assure Silver"
}
],
"type": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type",
"code": "01",
"display": "Individual"
}
]
},
"generalCost": [
{
"cost": {
"value": 200000,
"currency": "INR"
}
}
],
"specificCost": [
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 2000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "224663004",
"display": "Single room (environment)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "224663004",
"display": "Single room (environment)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 2000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit (environment)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit (environment)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 4000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "60689008",
"display": "Home care of patient"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "60689008",
"display": "Home care of patient"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 20000,
"unit": "INR"
}
}
]
}
]
}
]
},
{
"identifier": [
{
"use": "official",
"value": "Active Assure Silver"
}
],
"type": {
"coding": [
{
"system": "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-plan-type",
"code": "01",
"display": "Individual"
}
]
},
"generalCost": [
{
"cost": {
"value": 700000,
"currency": "INR"
}
}
],
"specificCost": [
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "49122002",
"display": "Ambulance, device (physical object)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 2000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "224663004",
"display": "Single room (environment)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "224663004",
"display": "Single room (environment)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 7000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit (environment)"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "309904001",
"display": "Intensive care unit (environment)"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 14000,
"unit": "INR"
}
}
]
}
]
},
{
"category": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "60689008",
"display": "Home care of patient"
}
]
},
"benefit": [
{
"type": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "60689008",
"display": "Home care of patient"
}
]
},
"cost": [
{
"type": {
"coding": [
{
"code": "fullcoverage"
}
]
},
"value": {
"value": 70000,
"unit": "INR"
}
}
]
}
]
}
]
}
]
}