{ "resourceType" : "InsurancePlan", "id" : "example-01", "meta" : { "versionId" : "1", "profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/InsurancePlan"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: InsurancePlan example-01

version: 1

Profile: InsurancePlan

ClaimSupportingInfoRequirement

ClaimSupportingInfoRequirement

ClaimExclusion

ClaimExclusion

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

-ExtensionType
*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

-ExtensionType
*Organ donor

plan

identifier: Active Assure Silver\u00a0(use:\u00a0official,\u00a0)

type: Individual

generalCost

Costs

-ValueCurrency
*200000Indian rupee

specificCost

category: Ambulance, device (physical object)

benefit

type: Ambulance, device (physical object)

Costs

-TypeValue
*fullcoverage2000 INR

specificCost

category: Single room (environment)

benefit

type: Single room (environment)

Costs

-TypeValue
*fullcoverage2000 INR

specificCost

category: Intensive care unit (environment)

benefit

type: Intensive care unit (environment)

Costs

-TypeValue
*fullcoverage4000 INR

specificCost

category: Home care of patient

benefit

type: Home care of patient

Costs

-TypeValue
*fullcoverage20000 INR

plan

identifier: Active Assure Silver\u00a0(use:\u00a0official,\u00a0)

type: Individual

generalCost

Costs

-ValueCurrency
*700000Indian rupee

specificCost

category: Ambulance, device (physical object)

benefit

type: Ambulance, device (physical object)

Costs

-TypeValue
*fullcoverage2000 INR

specificCost

category: Single room (environment)

benefit

type: Single room (environment)

Costs

-TypeValue
*fullcoverage7000 INR

specificCost

category: Intensive care unit (environment)

benefit

type: Intensive care unit (environment)

Costs

-TypeValue
*fullcoverage14000 INR

specificCost

category: Home care of patient

benefit

type: Home care of patient

Costs

-TypeValue
*fullcoverage70000 INR
" }, "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" } }] }] }] }] }