ClaimSupportingInfoRequirement
- category: Proof of identity
- code: Adhaar number
ClaimSupportingInfoRequirement
- category: Proof of address
- code: Passport number
ClaimExclusion
- category: Pre-Existing Diseases
- 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/procedure waiting period
- 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: Bundle: type = collection; timestamp = 2023-09-11 15:32:26+0530
administeredBy: Bundle: type = collection; timestamp = 2023-09-11 15:32:26+0530
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
coverage
type: Pre-hospital care (situation)
benefit
type: Pre-hospital care (situation)
Limits
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\u00a0(use:\u00a0official,\u00a0)
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\u00a0(use:\u00a0official,\u00a0)
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 |
"
},
"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" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion",
"code" : "Excl01",
"display" : "Pre-Existing Diseases"
}]
}
},
{
"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" : {
"coding" : [{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion",
"code" : "Excl02",
"display" : "Specified disease/procedure waiting period"
}]
}
},
{
"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" : "urn:uuid:ef131456-dc56-4d73-9e88-87d6cb12091e"
},
"administeredBy" : {
"reference" : "urn:uuid:ef131456-dc56-4d73-9e88-87d6cb12091e"
},
"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"
}
}]
}]
}]
}]
}
},
{
"fullUrl" : "urn:uuid:ef131456-dc56-4d73-9e88-87d6cb12091e",
"resource" : {
"resourceType" : "Organization",
"id" : "ef131456-dc56-4d73-9e88-87d6cb12091e",
"meta" : {
"profile" : ["https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"]
},
"text" : {
"status" : "generated",
"div" : ""
},
"identifier" : [{
"type" : {
"coding" : [{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ROHINI",
"display" : "Registry of Hospitals in Network of Insurance (ROHINI) ID"
}]
},
"system" : "https://rohini.iib.gov.in/",
"value" : "4567878"
}],
"name" : "XYZ insurance pvt. ltd.",
"telecom" : [{
"system" : "phone",
"value" : "+91 243 2634 1234",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@labs.xyz.org",
"use" : "work"
}]
}
}]
}