CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot United States of America flag

This page is part of the CARIN Digital Insurance Card (v2.0.0-ballot: STU2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 1.1.0. For a full list of available versions, see the Directory of published versions

CodeSystem: SBC Plan Type Code System (Experimental)

Official URL: http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type Version: 2.0.0-ballot
Standards status: Informative Computable Name: SBCPlanTypeCS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.9.16.6

Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type defines the following codes:

CodeDisplayDefinition
HMO Health Maintenance Organization (HMO) A type of health insurance plan that requires members to get health care services from doctors and hospitals in the plan's network, except in an emergency
PPO Preferred Provider Organization (PPO) A type of health insurance plan where members pay less if they use providers in the plan's network, but can use out-of-network providers at higher cost
POS Point of Service (POS) A type of health insurance plan where members pay less if they use doctors and hospitals in the plan's network and choose a primary care doctor to coordinate care
EPO Exclusive Provider Organization (EPO) A type of health insurance plan where services are covered only if members use doctors and providers in the plan's network, except in an emergency
HDHP High Deductible Health Plan (HDHP) A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account
INDEMNITY Indemnity Plan A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill