insurancePlan1.json

{
  "resourceType": "InsurancePlan",
  "id": "AB_GUJ_UniqueIdForTheObject",
  "identifier": [
    {
      "use": "usual",
      "value": "AB_GUJ_Plan1",
      "period": {
        "start": "2001-05-06"
      }
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/insurance-plan-type",
        "code": "medical"
      }
    ]
  },
  "name": "PMJAY-Mukhyamantri Amrutam & Mukhyamantri Vatsalya",
  "period": {
    "start": "2020-09-23"
  },
  "ownedBy": {
    "reference": "Organization/AB_GUJ_SHA",
    "display": "Gujarat State Health Protection Society"
  },
  "administeredBy": {
    "reference": "Organization/AB_GUJ_TPA_1",
    "display": "MD India Healthcare Service (TPA) Pvt. Ltd."
  },
  "coverageArea": {
    "reference": "Location/GUJARAT",
    "display": "Gujarat"
  },
  "coverage": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminologyServer/ValueSets/coverage-type",
            "code": "Medical"
          }
        ]
      },
      "benefit": [
        {
          "type": {
            "coding": [
              {
                "system": "http://terminologyServer/ValueSets/benefit-type",
                "code": "Inpatient"
              }
            ]
          },
          "limit": {
            "value": {
              "value": 500000,
              "unit": "INR"
            }
          }
        }
      ]
    }
  ],
  "plan": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminologyServer/ValueSets/plan-type",
            "code": "PMJAY_GUJ_GOLD_CARD"
          }
        ]
      },
      "extension": [
        {
          "url": "https://hcx-base-url/StructureDefinition/HCXProofOfIdentificationExtension",
          "extension": [
            {
              "url": "ProofOfIdentificationDocumentCode",
              "valueCodeableConcept": {
                "coding":  [
                    {
                        "system": "https://hcx-valuesets/proofOfIdentificationDocumentCodes",
                        "version": "1.0.0",
                        "code": "12345",
                        "display": "Aadhar Card"
                    }
                ]
              }
            },
            {
              "url": "ProofOfIdentificationDocumentRequiredFlag",
              "valueBoolean": true
            },
            {
              "url": "ProofOfIdentificationDocumentMimeType",
              "valueCode": "application/pdf"
            },
            {
              "url": "ClinicalDiagnosticDocumentClaimUse",
              "valueCode": "preauthorization"
            },
            {
              "url": "DocumentationUrl",
              "valueUrl": "http://documentation-url"
            }
          ]
        },
        {
          "url": "https://hcx-base-url/StructureDefinition/HCXProofOfPresenceExtension",
          "extension": [
            {
              "url": "ProofOfPresenceDocumentCode",
              "valueCodeableConcept": {
                "coding":  [
                    {
                        "system": "https://hcx-valuesets/proofOfPresenceDocumentCodes",
                        "version": "1.0.0",
                        "code": "45678",
                        "display": "Aadhar Verification XML"
                    }
                ]
              }
            },
            {
              "url": "ProofOfPresenceDocumentRequiredFlag",
              "valueBoolean": true
            },
            {
              "url": "ProofOfPresenceDocumentMimeType",
              "valueCode": "application/xml"
            },
            {
              "url": "ClinicalDiagnosticDocumentClaimUse",
              "valueCode": "preauthorization"
            },
            {
              "url": "DocumentationUrl",
              "valueUrl": "http://documentation-url"
            }
          ]
        }
      ],
      "specificCost": [
        {
          "category": {
            "coding": [
              {
                "system": "http://terminologyServer/ValueSets/cost-category",
                "code": "Inpatient-packages"
              }
            ]
          },
          "benefit": [
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminologyServer/ValueSets/packages",
                    "code": "IN010",
                    "display": "Vertebroplasty"
                  }
                ]
              },
              "cost": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/pacakgeCostTypes",
                        "code": "hospitalization"
                      }
                    ]
                  },
                  "applicability": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/applicabilityCodes",
                        "code": "in-network",
                        "display": "Gujarat SHA empaneled hospitals"
                      }
                    ]
                  },
                  "value": {
                    "value": 22800,
                    "unit": "INR"
                  }
                }
              ]
            },
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminologyServer/ValueSets/procedures",
                    "code": "MC999A",
                    "display": "ABC Surgery"
                  },
                  {
                    "system": "ICD PCS codes",
                    "code": "ICD_PCS_001"
                  }
                ]
              },
              "cost": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/pacakgeCostTypes",
                        "code": "hospitalization"
                      }
                    ]
                  },
                  "applicability": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/applicabilityCodes",
                        "code": "in-network",
                        "display": "Gujarat SHA empaneled hospitals"
                      }
                    ]
                  },
                  "value": {
                    "value": 11000,
                    "unit": "INR"
                  }
                },
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/pacakgeCostTypes",
                        "code": "hospitalization"
                      }
                    ]
                  },
                  "applicability": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/applicabilityCodes",
                        "code": "in-network",
                        "display": "Gujarat SHA empaneled hospitals"
                      }
                    ]
                  },
                  "qualifiers": [
                    {
                      "coding": [
                        {
                          "system": "http://terminologyServer/ValueSets/stratificationTypes",
                          "code": "STRAT002"
                        }
                      ]
                    },
                    {
                      "coding": [
                        {
                          "system": "http://terminologyServer/ValueSets/implantCodes",
                          "code": "IMP0005"
                        }
                      ]
                    }
                  ],
                  "value": {
                    "value": 12000,
                    "unit": "INR"
                  }
                }
              ]
            },
            {
              "type": {
                "coding": [
                  {
                    "system": "http://terminologyServer/ValueSets/packages",
                    "code": "HBP_PACKAGE_00003",
                    "display": "Microlaryngoscopic Surgery"
                  }
                ]
              },
              "cost": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/pacakgeCostTypes",
                        "code": "hospitalization"
                      }
                    ]
                  },
                  "applicability": {
                    "coding": [
                      {
                        "system": "http://terminologyServer/ValueSets/applicabilityCodes",
                        "code": "in-network",
                        "display": "Gujarat SHA empaneled hospitals"
                      }
                    ]
                  },
                  "qualifiers": [
                    {
                      "coding": [
                        {
                          "system": "http://terminologyServer/ValueSets/stratificationTypes",
                          "code": "STRAT002"
                        }
                      ]
                    },
                    {
                      "coding": [
                        {
                          "system": "http://terminologyServer/ValueSets/implantCodes",
                          "code": "IMP0005"
                        }
                      ]
                    }
                  ],
                  "value": {
                    "value": 18500,
                    "unit": "INR"
                  }
                }
              ],
              "extension": [
                {
                  "url": "https://hcx-base-url/StructureDefinition/HCXDiagnosticDocumentsExtension",
                  "extension": [
                    {
                      "url": "ClinicalDiagnosticDocumentCode",
                      "valueCodeableConcept": {
                        "coding":  [
                            {
                                "system": "https://hcx-valuesets/clinicalDiagnosticsDocumentCodes",
                                "version": "1.0.0",
                                "code": "DOC-001",
                                "display": "Investigation Report 1"
                            }
                        ]
                      }
                    },
                    {
                      "url": "ClinicalDiagnosticDocumentRequiredFlag",
                      "valueBoolean": true
                    },
                    {
                      "url": "ClinicalDiagnosticDocumentMimeType",
                      "valueCode": "application/pdf"
                    },
                    {
                      "url": "ClinicalDiagnosticDocumentClaimUse",
                      "valueCode": "claim"
                    },
                    {
                      "url": "DocumentationUrl",
                      "valueUrl": "http://documentation-url"
                    }
                  ]
                },
                {
                  "url": "https://hcx-base-url/StructureDefinition/HCXInformationalMessagesExtension",
                  "extension": [
                    {
                      "url": "InformationalMessagesCode",
                      "valueCodeableConcept": {
                        "coding":  [
                            {
                                "system": "https://hcx-valuesets/InformationalMessagesCodes",
                                "version": "1.0.0",
                                "code": "INF-001",
                                "display": "Information Message 1"
                            }
                        ]
                      }
                    },
                    {
                      "url": "InformationalMessageCode",
                      "valueCode": "information"
                    },
                    {
                      "url": "InformationalMessageClaimUse",
                      "valueCode": "claim"
                    },
                    {
                      "url": "DocumentationUrl",
                      "valueUrl": "http://documentation-url"
                    }
                  ]
                },
                {
                  "url": "https://hcx-base-url/StructureDefinition/HCXQuestionnairesExtension",
                  "extension": [
                    {
                      "url": "Questionnaire",
                      "valueReference": {
                        "reference": "Questionnnaire/1"
                      }
                    },
                    {
                      "url": "QuestionnaireRequiredFlag",
                      "valueBoolean": true
                    },
                    {
                      "url": "QuestionnaireClaimUse",
                      "valueCode": "claim"
                    },
                    {
                      "url": "DocumentationUrl",
                      "valueUrl": "http://documentation-url"
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}