Atrius India Core FHIR Implementation Guide
0.1.0 - ci-build

Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Atrius India Core InsurancePlan

Official URL: https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-insuranceplan Version: 0.1.0
Draft as of 2026-08-30 Computable Name: AtriusInInsurancePlan
Other Identifiers: OID:1.3.6.1.4.1.66219.1.42.69

Atrius India Core profile. Parent: FHIR R4. NDHM 6.5.0 InsurancePlan parity, including NDHM min cardinalities so Claim-* extension context checks succeed.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan(4.0.1) Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (6.5.0) (example)
.... coding Σ 0..1 Coding Code defined by a terminology system
..... system Σ 1..1 uri Identity of the terminology system
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy SΣ 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... benefit S 1..* BackboneElement List of benefits
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Plan details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... generalCost S 0..* BackboneElement Overall costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... specificCost S 0..* BackboneElement Specific costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... coding Σ 0..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error InsurancePlan.implicitRules, InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.identifier, InsurancePlan.status, InsurancePlan.type, InsurancePlan.type.coding, InsurancePlan.type.coding.system, InsurancePlan.type.coding.code, InsurancePlan.type.coding.display, InsurancePlan.type.text, InsurancePlan.name, InsurancePlan.alias, InsurancePlan.period, InsurancePlan.ownedBy, InsurancePlan.administeredBy, InsurancePlan.coverageArea, InsurancePlan.contact, InsurancePlan.contact.modifierExtension, InsurancePlan.network, InsurancePlan.coverage, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type, InsurancePlan.coverage.type.coding, InsurancePlan.coverage.type.coding.system, InsurancePlan.coverage.type.coding.code, InsurancePlan.coverage.type.coding.display, InsurancePlan.coverage.type.text, InsurancePlan.coverage.benefit, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type, InsurancePlan.coverage.benefit.type.coding, InsurancePlan.coverage.benefit.type.coding.system, InsurancePlan.coverage.benefit.type.coding.code, InsurancePlan.coverage.benefit.type.coding.display, InsurancePlan.coverage.benefit.type.text, InsurancePlan.plan, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.type, InsurancePlan.plan.type.coding, InsurancePlan.plan.type.coding.system, InsurancePlan.plan.type.coding.code, InsurancePlan.plan.type.coding.display, InsurancePlan.plan.type.text, InsurancePlan.plan.coverageArea, InsurancePlan.plan.generalCost, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category, InsurancePlan.plan.specificCost.category.coding, InsurancePlan.plan.specificCost.category.coding.system, InsurancePlan.plan.specificCost.category.coding.code, InsurancePlan.plan.specificCost.category.coding.display, InsurancePlan.plan.specificCost.category.text, InsurancePlan.plan.specificCost.benefit, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type, InsurancePlan.plan.specificCost.benefit.type.coding, InsurancePlan.plan.specificCost.benefit.type.coding.system, InsurancePlan.plan.specificCost.benefit.type.coding.code, InsurancePlan.plan.specificCost.benefit.type.coding.display, InsurancePlan.plan.specificCost.benefit.type.text All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.contact.modifierExtension, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.benefit.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan InsurancePlan(4.0.1)
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... identifier S 1..1 Identifier Business Identifier for Product
... status S 1..1 code draft | active | retired | unknown
.... coding 0..1 Coding Code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... name S 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy S 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy S 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea S 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... benefit S 1..* BackboneElement List of benefits
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Plan details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... coverageArea S 0..* Reference(Location) Where product applies
.... generalCost S 0..* BackboneElement Overall costs
.... specificCost S 0..* BackboneElement Specific costs
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... benefit
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... coding 0..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
........ code 1..1 code Symbol in syntax defined by the system
........ display 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan(4.0.1) Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier SΣC 1..1 Identifier Business Identifier for Product
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (6.5.0) (example)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... coding Σ 0..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy SΣ 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan S 0..* BackboneElement Plan details
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost S 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... coding Σ 0..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
........ system Σ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error InsurancePlan.meta, InsurancePlan.implicitRules, InsurancePlan.language, InsurancePlan.text, InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.identifier, InsurancePlan.status, InsurancePlan.type, InsurancePlan.type.extension, InsurancePlan.type.coding, InsurancePlan.type.coding.extension, InsurancePlan.type.coding.system, InsurancePlan.type.coding.version, InsurancePlan.type.coding.code, InsurancePlan.type.coding.display, InsurancePlan.type.coding.userSelected, InsurancePlan.type.text, InsurancePlan.name, InsurancePlan.alias, InsurancePlan.period, InsurancePlan.ownedBy, InsurancePlan.administeredBy, InsurancePlan.coverageArea, InsurancePlan.contact, InsurancePlan.contact.extension, InsurancePlan.contact.modifierExtension, InsurancePlan.contact.purpose, InsurancePlan.contact.name, InsurancePlan.contact.telecom, InsurancePlan.contact.address, InsurancePlan.endpoint, InsurancePlan.network, InsurancePlan.coverage, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type, InsurancePlan.coverage.type.extension, InsurancePlan.coverage.type.coding, InsurancePlan.coverage.type.coding.extension, InsurancePlan.coverage.type.coding.system, InsurancePlan.coverage.type.coding.version, InsurancePlan.coverage.type.coding.code, InsurancePlan.coverage.type.coding.display, InsurancePlan.coverage.type.coding.userSelected, InsurancePlan.coverage.type.text, InsurancePlan.coverage.network, InsurancePlan.coverage.benefit, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type, InsurancePlan.coverage.benefit.type.extension, InsurancePlan.coverage.benefit.type.coding, InsurancePlan.coverage.benefit.type.coding.extension, InsurancePlan.coverage.benefit.type.coding.system, InsurancePlan.coverage.benefit.type.coding.version, InsurancePlan.coverage.benefit.type.coding.code, InsurancePlan.coverage.benefit.type.coding.display, InsurancePlan.coverage.benefit.type.coding.userSelected, InsurancePlan.coverage.benefit.type.text, InsurancePlan.coverage.benefit.requirement, InsurancePlan.coverage.benefit.limit, InsurancePlan.coverage.benefit.limit.extension, InsurancePlan.coverage.benefit.limit.modifierExtension, InsurancePlan.coverage.benefit.limit.value, InsurancePlan.coverage.benefit.limit.code, InsurancePlan.plan, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.identifier, InsurancePlan.plan.type, InsurancePlan.plan.type.extension, InsurancePlan.plan.type.coding, InsurancePlan.plan.type.coding.extension, InsurancePlan.plan.type.coding.system, InsurancePlan.plan.type.coding.version, InsurancePlan.plan.type.coding.code, InsurancePlan.plan.type.coding.display, InsurancePlan.plan.type.coding.userSelected, InsurancePlan.plan.type.text, InsurancePlan.plan.coverageArea, InsurancePlan.plan.network, InsurancePlan.plan.generalCost, InsurancePlan.plan.generalCost.extension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.generalCost.type, InsurancePlan.plan.generalCost.groupSize, InsurancePlan.plan.generalCost.cost, InsurancePlan.plan.generalCost.comment, InsurancePlan.plan.specificCost, InsurancePlan.plan.specificCost.extension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category, InsurancePlan.plan.specificCost.category.extension, InsurancePlan.plan.specificCost.category.coding, InsurancePlan.plan.specificCost.category.coding.extension, InsurancePlan.plan.specificCost.category.coding.system, InsurancePlan.plan.specificCost.category.coding.version, InsurancePlan.plan.specificCost.category.coding.code, InsurancePlan.plan.specificCost.category.coding.display, InsurancePlan.plan.specificCost.category.coding.userSelected, InsurancePlan.plan.specificCost.category.text, InsurancePlan.plan.specificCost.benefit, InsurancePlan.plan.specificCost.benefit.extension, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type, InsurancePlan.plan.specificCost.benefit.type.extension, InsurancePlan.plan.specificCost.benefit.type.coding, InsurancePlan.plan.specificCost.benefit.type.coding.extension, InsurancePlan.plan.specificCost.benefit.type.coding.system, InsurancePlan.plan.specificCost.benefit.type.coding.version, InsurancePlan.plan.specificCost.benefit.type.coding.code, InsurancePlan.plan.specificCost.benefit.type.coding.display, InsurancePlan.plan.specificCost.benefit.type.coding.userSelected, InsurancePlan.plan.specificCost.benefit.type.text, InsurancePlan.plan.specificCost.benefit.cost, InsurancePlan.plan.specificCost.benefit.cost.extension, InsurancePlan.plan.specificCost.benefit.cost.modifierExtension, InsurancePlan.plan.specificCost.benefit.cost.type, InsurancePlan.plan.specificCost.benefit.cost.applicability, InsurancePlan.plan.specificCost.benefit.cost.qualifiers, InsurancePlan.plan.specificCost.benefit.cost.value All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.type.extension, InsurancePlan.type.coding.extension, InsurancePlan.contact.extension, InsurancePlan.contact.modifierExtension, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type.extension, InsurancePlan.coverage.type.coding.extension, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type.extension, InsurancePlan.coverage.benefit.type.coding.extension, InsurancePlan.coverage.benefit.limit.extension, InsurancePlan.coverage.benefit.limit.modifierExtension, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.type.extension, InsurancePlan.plan.type.coding.extension, InsurancePlan.plan.generalCost.extension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost.extension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category.extension, InsurancePlan.plan.specificCost.category.coding.extension, InsurancePlan.plan.specificCost.benefit.extension, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type.extension, InsurancePlan.plan.specificCost.benefit.type.coding.extension, InsurancePlan.plan.specificCost.benefit.cost.extension, InsurancePlan.plan.specificCost.benefit.cost.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan(4.0.1) Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (6.5.0) (example)
.... coding Σ 0..1 Coding Code defined by a terminology system
..... system Σ 1..1 uri Identity of the terminology system
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy SΣ 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... benefit S 1..* BackboneElement List of benefits
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Plan details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... coding Σ 0..1 Coding Code defined by a terminology system
...... system Σ 1..1 uri Identity of the terminology system
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... generalCost S 0..* BackboneElement Overall costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... specificCost S 0..* BackboneElement Specific costs
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... coding Σ 0..1 Coding Code defined by a terminology system
....... system Σ 1..1 uri Identity of the terminology system
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... coding Σ 0..1 Coding Code defined by a terminology system
........ system Σ 1..1 uri Identity of the terminology system
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
....... text SΣ 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error InsurancePlan.implicitRules, InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.identifier, InsurancePlan.status, InsurancePlan.type, InsurancePlan.type.coding, InsurancePlan.type.coding.system, InsurancePlan.type.coding.code, InsurancePlan.type.coding.display, InsurancePlan.type.text, InsurancePlan.name, InsurancePlan.alias, InsurancePlan.period, InsurancePlan.ownedBy, InsurancePlan.administeredBy, InsurancePlan.coverageArea, InsurancePlan.contact, InsurancePlan.contact.modifierExtension, InsurancePlan.network, InsurancePlan.coverage, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type, InsurancePlan.coverage.type.coding, InsurancePlan.coverage.type.coding.system, InsurancePlan.coverage.type.coding.code, InsurancePlan.coverage.type.coding.display, InsurancePlan.coverage.type.text, InsurancePlan.coverage.benefit, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type, InsurancePlan.coverage.benefit.type.coding, InsurancePlan.coverage.benefit.type.coding.system, InsurancePlan.coverage.benefit.type.coding.code, InsurancePlan.coverage.benefit.type.coding.display, InsurancePlan.coverage.benefit.type.text, InsurancePlan.plan, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.type, InsurancePlan.plan.type.coding, InsurancePlan.plan.type.coding.system, InsurancePlan.plan.type.coding.code, InsurancePlan.plan.type.coding.display, InsurancePlan.plan.type.text, InsurancePlan.plan.coverageArea, InsurancePlan.plan.generalCost, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category, InsurancePlan.plan.specificCost.category.coding, InsurancePlan.plan.specificCost.category.coding.system, InsurancePlan.plan.specificCost.category.coding.code, InsurancePlan.plan.specificCost.category.coding.display, InsurancePlan.plan.specificCost.category.text, InsurancePlan.plan.specificCost.benefit, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type, InsurancePlan.plan.specificCost.benefit.type.coding, InsurancePlan.plan.specificCost.benefit.type.coding.system, InsurancePlan.plan.specificCost.benefit.type.coding.code, InsurancePlan.plan.specificCost.benefit.type.coding.display, InsurancePlan.plan.specificCost.benefit.type.text All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.contact.modifierExtension, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.benefit.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan InsurancePlan(4.0.1)
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
... identifier S 1..1 Identifier Business Identifier for Product
... status S 1..1 code draft | active | retired | unknown
.... coding 0..1 Coding Code defined by a terminology system
..... system 1..1 uri Identity of the terminology system
..... code 1..1 code Symbol in syntax defined by the system
..... display 1..1 string Representation defined by the system
.... text S 0..1 string Plain text representation of the concept
... name S 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy S 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy S 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea S 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... benefit S 1..* BackboneElement List of benefits
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
... plan S 0..* BackboneElement Plan details
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... coding 0..1 Coding Code defined by a terminology system
...... system 1..1 uri Identity of the terminology system
...... code 1..1 code Symbol in syntax defined by the system
...... display 1..1 string Representation defined by the system
..... text S 0..1 string Plain text representation of the concept
.... coverageArea S 0..* Reference(Location) Where product applies
.... generalCost S 0..* BackboneElement Overall costs
.... specificCost S 0..* BackboneElement Specific costs
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... coding 0..1 Coding Code defined by a terminology system
....... system 1..1 uri Identity of the terminology system
....... code 1..1 code Symbol in syntax defined by the system
....... display 1..1 string Representation defined by the system
...... text S 0..1 string Plain text representation of the concept
..... benefit
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... coding 0..1 Coding Code defined by a terminology system
........ system 1..1 uri Identity of the terminology system
........ code 1..1 code Symbol in syntax defined by the system
........ display 1..1 string Representation defined by the system
....... text S 0..1 string Plain text representation of the concept

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. InsurancePlan C 0..* InsurancePlan(4.0.1) Details of a Health Insurance product/plan provided by an organization
Constraints: ipn-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
.... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
.... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier SΣC 1..1 Identifier Business Identifier for Product
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.
... type SΣ 1..1 CodeableConcept Kind of product
Binding: InsurancePlanType (6.5.0) (example)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... coding Σ 0..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... system Σ 1..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Symbol in syntax defined by the system
..... display Σ 1..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text SΣ 0..1 string Plain text representation of the concept
... name SΣC 1..1 string Official name
... alias S 0..* string Alternate names
... period S 1..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(Atrius India Core Organization(0.1.0)) Plan issuer
... administeredBy SΣ 0..1 Reference(Atrius India Core Organization(0.1.0)) Product administrator
... coverageArea SΣ 0..* Reference(Location) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... purpose 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.
.... name 0..1 HumanName A name associated with the contact
.... telecom 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint 0..* Reference(Endpoint) Technical endpoint
... network S 0..* Reference(Organization) What networks are Included
... coverage S 1..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claim-supportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Type of coverage
Binding: CoverageType (6.5.0) (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... network 0..* Reference(Organization) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
...... extension:claim-condition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
...... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 1..1 CodeableConcept Type of benefit
Binding: BenefitType (6.5.0) (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... requirement 0..1 string Referral requirements
..... limit 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... value 0..1 Quantity Maximum value allowed
...... code 0..1 CodeableConcept Benefit limit details
... plan S 0..* BackboneElement Plan details
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Constraints: ext-1
..... extension:claim-exclusion 0..* (Complex) Excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
Constraints: ext-1
..... extension:claimCondition 0..* (Complex) Outlines specific conditions and criteria that may be required to successfully claim benefits under a coverage within a insurance product.
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Condition
Constraints: ext-1
..... extension:claimSupportingInfoRequirement 0..* (Complex) Enumerates essential documentation necessary for a health insurance product during claim processing. e.g. proof of identity, proof of address
URL: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-SupportingInfoRequirement
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... identifier Σ 0..* Identifier Business Identifier for Product
.... type S 1..1 CodeableConcept Type of plan
Binding: PlanType (6.5.0) (example)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
..... coding Σ 0..1 Coding Code defined by a terminology system
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 1..1 code Symbol in syntax defined by the system
...... display Σ 1..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text SΣ 0..1 string Plain text representation of the concept
.... coverageArea SΣ 0..* Reference(Location) Where product applies
.... network 0..* Reference(Organization) What networks provide coverage
.... generalCost S 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... type 0..1 CodeableConcept Type of cost
..... groupSize 0..1 positiveInt Number of enrollees
..... cost 0..1 Money Cost value
..... comment 0..1 string Additional cost information
.... specificCost S 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
..... category S 1..1 CodeableConcept General category of benefit
Binding: BenefitCategory (6.5.0) (example)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... coding Σ 0..1 Coding Code defined by a terminology system
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... system Σ 1..1 uri Identity of the terminology system
....... version Σ 0..1 string Version of the system - if relevant
....... code Σ 1..1 code Symbol in syntax defined by the system
....... display Σ 1..1 string Representation defined by the system
....... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
...... text SΣ 0..1 string Plain text representation of the concept
..... benefit 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
...... type 1..1 CodeableConcept Type of specific benefit
Binding: ProductorService (6.5.0) (example)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
....... coding Σ 0..1 Coding Code defined by a terminology system
........ id 0..1 string Unique id for inter-element referencing
........ extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
........ system Σ 1..1 uri Identity of the terminology system
........ version Σ 0..1 string Version of the system - if relevant
........ code Σ 1..1 code Symbol in syntax defined by the system
........ display Σ 1..1 string Representation defined by the system
........ userSelected Σ 0..1 boolean If this coding was chosen directly by the user
....... text SΣ 0..1 string Plain text representation of the concept
...... cost 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
....... type 1..1 CodeableConcept Type of cost
....... applicability 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.
....... qualifiers 0..* CodeableConcept Additional information about the cost
....... value 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
InsurancePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
InsurancePlan.status Base required PublicationStatus 📍4.0.1 FHIR Std.
InsurancePlan.type Base example InsurancePlan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.contact.​purpose Base extensible Contact entity type 📍4.0.1 FHIR Std.
InsurancePlan.coverage.​type Base example Coverage Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.coverage.​benefit.type Base example Benefit Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.type Base example Plan Type 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​category Base example Benefit Category 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.type Base example ProductorService 📍6.5.0 FHIR Implementation Guide for ABDM v6.5
InsurancePlan.plan.specificCost.​benefit.cost.applicability Base required Benefit cost applicability 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error InsurancePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error InsurancePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error InsurancePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice InsurancePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error InsurancePlan.meta, InsurancePlan.implicitRules, InsurancePlan.language, InsurancePlan.text, InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.identifier, InsurancePlan.status, InsurancePlan.type, InsurancePlan.type.extension, InsurancePlan.type.coding, InsurancePlan.type.coding.extension, InsurancePlan.type.coding.system, InsurancePlan.type.coding.version, InsurancePlan.type.coding.code, InsurancePlan.type.coding.display, InsurancePlan.type.coding.userSelected, InsurancePlan.type.text, InsurancePlan.name, InsurancePlan.alias, InsurancePlan.period, InsurancePlan.ownedBy, InsurancePlan.administeredBy, InsurancePlan.coverageArea, InsurancePlan.contact, InsurancePlan.contact.extension, InsurancePlan.contact.modifierExtension, InsurancePlan.contact.purpose, InsurancePlan.contact.name, InsurancePlan.contact.telecom, InsurancePlan.contact.address, InsurancePlan.endpoint, InsurancePlan.network, InsurancePlan.coverage, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type, InsurancePlan.coverage.type.extension, InsurancePlan.coverage.type.coding, InsurancePlan.coverage.type.coding.extension, InsurancePlan.coverage.type.coding.system, InsurancePlan.coverage.type.coding.version, InsurancePlan.coverage.type.coding.code, InsurancePlan.coverage.type.coding.display, InsurancePlan.coverage.type.coding.userSelected, InsurancePlan.coverage.type.text, InsurancePlan.coverage.network, InsurancePlan.coverage.benefit, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type, InsurancePlan.coverage.benefit.type.extension, InsurancePlan.coverage.benefit.type.coding, InsurancePlan.coverage.benefit.type.coding.extension, InsurancePlan.coverage.benefit.type.coding.system, InsurancePlan.coverage.benefit.type.coding.version, InsurancePlan.coverage.benefit.type.coding.code, InsurancePlan.coverage.benefit.type.coding.display, InsurancePlan.coverage.benefit.type.coding.userSelected, InsurancePlan.coverage.benefit.type.text, InsurancePlan.coverage.benefit.requirement, InsurancePlan.coverage.benefit.limit, InsurancePlan.coverage.benefit.limit.extension, InsurancePlan.coverage.benefit.limit.modifierExtension, InsurancePlan.coverage.benefit.limit.value, InsurancePlan.coverage.benefit.limit.code, InsurancePlan.plan, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.identifier, InsurancePlan.plan.type, InsurancePlan.plan.type.extension, InsurancePlan.plan.type.coding, InsurancePlan.plan.type.coding.extension, InsurancePlan.plan.type.coding.system, InsurancePlan.plan.type.coding.version, InsurancePlan.plan.type.coding.code, InsurancePlan.plan.type.coding.display, InsurancePlan.plan.type.coding.userSelected, InsurancePlan.plan.type.text, InsurancePlan.plan.coverageArea, InsurancePlan.plan.network, InsurancePlan.plan.generalCost, InsurancePlan.plan.generalCost.extension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.generalCost.type, InsurancePlan.plan.generalCost.groupSize, InsurancePlan.plan.generalCost.cost, InsurancePlan.plan.generalCost.comment, InsurancePlan.plan.specificCost, InsurancePlan.plan.specificCost.extension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category, InsurancePlan.plan.specificCost.category.extension, InsurancePlan.plan.specificCost.category.coding, InsurancePlan.plan.specificCost.category.coding.extension, InsurancePlan.plan.specificCost.category.coding.system, InsurancePlan.plan.specificCost.category.coding.version, InsurancePlan.plan.specificCost.category.coding.code, InsurancePlan.plan.specificCost.category.coding.display, InsurancePlan.plan.specificCost.category.coding.userSelected, InsurancePlan.plan.specificCost.category.text, InsurancePlan.plan.specificCost.benefit, InsurancePlan.plan.specificCost.benefit.extension, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type, InsurancePlan.plan.specificCost.benefit.type.extension, InsurancePlan.plan.specificCost.benefit.type.coding, InsurancePlan.plan.specificCost.benefit.type.coding.extension, InsurancePlan.plan.specificCost.benefit.type.coding.system, InsurancePlan.plan.specificCost.benefit.type.coding.version, InsurancePlan.plan.specificCost.benefit.type.coding.code, InsurancePlan.plan.specificCost.benefit.type.coding.display, InsurancePlan.plan.specificCost.benefit.type.coding.userSelected, InsurancePlan.plan.specificCost.benefit.type.text, InsurancePlan.plan.specificCost.benefit.cost, InsurancePlan.plan.specificCost.benefit.cost.extension, InsurancePlan.plan.specificCost.benefit.cost.modifierExtension, InsurancePlan.plan.specificCost.benefit.cost.type, InsurancePlan.plan.specificCost.benefit.cost.applicability, InsurancePlan.plan.specificCost.benefit.cost.qualifiers, InsurancePlan.plan.specificCost.benefit.cost.value All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error InsurancePlan.extension, InsurancePlan.extension:claim-exclusion, InsurancePlan.extension:claim-supportingInfoRequirement, InsurancePlan.modifierExtension, InsurancePlan.type.extension, InsurancePlan.type.coding.extension, InsurancePlan.contact.extension, InsurancePlan.contact.modifierExtension, InsurancePlan.coverage.extension, InsurancePlan.coverage.extension:claim-condition, InsurancePlan.coverage.extension:claim-supportingInfoRequirement, InsurancePlan.coverage.modifierExtension, InsurancePlan.coverage.type.extension, InsurancePlan.coverage.type.coding.extension, InsurancePlan.coverage.benefit.extension, InsurancePlan.coverage.benefit.extension:claim-condition, InsurancePlan.coverage.benefit.extension:claimSupportingInfoRequirement, InsurancePlan.coverage.benefit.modifierExtension, InsurancePlan.coverage.benefit.type.extension, InsurancePlan.coverage.benefit.type.coding.extension, InsurancePlan.coverage.benefit.limit.extension, InsurancePlan.coverage.benefit.limit.modifierExtension, InsurancePlan.plan.extension, InsurancePlan.plan.extension:claim-exclusion, InsurancePlan.plan.extension:claimCondition, InsurancePlan.plan.extension:claimSupportingInfoRequirement, InsurancePlan.plan.modifierExtension, InsurancePlan.plan.type.extension, InsurancePlan.plan.type.coding.extension, InsurancePlan.plan.generalCost.extension, InsurancePlan.plan.generalCost.modifierExtension, InsurancePlan.plan.specificCost.extension, InsurancePlan.plan.specificCost.modifierExtension, InsurancePlan.plan.specificCost.category.extension, InsurancePlan.plan.specificCost.category.coding.extension, InsurancePlan.plan.specificCost.benefit.extension, InsurancePlan.plan.specificCost.benefit.modifierExtension, InsurancePlan.plan.specificCost.benefit.type.extension, InsurancePlan.plan.specificCost.benefit.type.coding.extension, InsurancePlan.plan.specificCost.benefit.cost.extension, InsurancePlan.plan.specificCost.benefit.cost.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()
ipn-1 error InsurancePlan The organization SHALL at least have a name or an idendtifier, and possibly more than one (identifier.count() + name.count()) > 0

 

Other representations of profile: CSV, Excel, Schematron