description: This extension specifies excluded coverage details within a health insurance product. It outlines services, treatments or conditions not covered.
package_name: ndhm.in
derivation: constraint
name: ClaimExclusion
type: Extension
elements:
  extension:
    short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
    binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-exclusion'}
    index: 0
    slicing:
      slices:
        category:
          match: {}
          schema:
            short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
            binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-exclusion'}
            index: 0
            elements:
              url:
                pattern: {type: Uri, value: category}
                index: 1
              value:
                choices: [valueCodeableConcept]
                index: 3
              valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 4}
        statement:
          match: {}
          schema:
            short: General statement about the exclusion.
            index: 5
            elements:
              url:
                pattern: {type: Uri, value: statement}
                index: 6
              value:
                choices: [valueString]
                index: 8
              valueString: {type: string, choiceOf: value, index: 9}
        item:
          match: {}
          schema:
            short: Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc.
            index: 10
            elements:
              url:
                pattern: {type: Uri, value: item}
                index: 11
              value:
                choices: [valueCodeableConcept]
                index: 13
              valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 14}
  url:
    pattern: {type: Uri, value: 'https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion'}
    index: 15
  value:
    choices: []
    index: 17
package_version: 5.0.0
extensions:
  category:
    url: null
    short: 'Illustrates a standard or specific exclusion category e.g: pre-existing diseases, specific disease/procedure waiting period.'
    binding: {strength: example, valueSet: 'https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-exclusion'}
    index: 0
    elements:
      url:
        pattern: {type: Uri, value: category}
        index: 1
      value:
        choices: [valueCodeableConcept]
        index: 3
      valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 4}
  statement:
    url: null
    short: General statement about the exclusion.
    index: 5
    elements:
      url:
        pattern: {type: Uri, value: statement}
        index: 6
      value:
        choices: [valueString]
        index: 8
      valueString: {type: string, choiceOf: value, index: 9}
  item:
    url: null
    short: Outline list of medical illness, associated treatments, as well as other non-medical items that are excluded from the health insurance product. e.g. cataract surgery, skin tumour, baby food etc.
    index: 10
    elements:
      url:
        pattern: {type: Uri, value: item}
        index: 11
      value:
        choices: [valueCodeableConcept]
        index: 13
      valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 14}
class: extension
kind: complex-type
url: https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim-Exclusion
base: http://hl7.org/fhir/StructureDefinition/Extension
version: 5.0.0