CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot

CARIN Digital Insurance Card - Downloaded Version 2.0.0-ballot See the Directory of published versions

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

C4DIC CapabilityStatement | This Section describes the expected capabilities of the C4DIC Server actor which is responsible for providing responses to the queries submitted by the C4DIC Requestors.

### Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

C4DIC Coverage | Data that reflect a payer’s coverage of the member.
C4DIC Organization | This profile builds upon the US Core Organization profile. It is used to convey a payer organization.
C4DIC Patient | The goal of this profile is to describe a data-minimized version of Patient used to convey information about the Member who has health insurance coverage. Information that would normally not appear on a health insurance card is not required. The use of this profile is only approved for conveying information related to a health insurance card as part of this IG.
SBC Insurance Plan Profile | Profile of InsurancePlan resource for representing Summary of Benefits and Coverage (SBC) documents as required under ACA Section 2715 and implementing regulations at 45 CFR 147.200, 29 CFR 2590.715-2715, and 26 CFR 54.9815-2715

### Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

Additional Insurance Card Information | This extension enables the passing of free text items often found on insurance cards or references to related resources such as Summary of Benefits and Coverage (SBC) documents. Health plans may provide this extension as part of the Coverage resource to communicate concepts such as TTY, disclaimers about eligibility or limits to coverage, notice of dental or vision coverage, or to link to a structured SBC InsurancePlan resource.
Background Color | This extension enables an insurance company to provide a background color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member. When rendering foreground and background colors, the implementer should not use the same foreground and background colors and instead should algorithmically determine a high color contrast.
Barcode | This extension enables payers to provide an image of the barcode found on a member’s physicial insurance card. This image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. Often there are data elements relevant to the health plan coverage encoded in the barcode. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.
Beneficiary Cost as String | This extension allows for the representation of copay details as strings. This can be passed as part of the Coverage resource where payors need to communicate costToBeneficiary details that cannot be expressed as SimpleQuantity or Money data types.
Benefit Limitation Extension | Extension for documenting limitations and exceptions that apply to specific benefits in the SBC, carrying the limitation text as displayed along with an optional structured representation of the limit (type, value, and period)
Card Issue Date | This extension allows for the expression of the date at which the insurance card was issued by the payer. The health plan may pass this along with the Coverage resource to indicate when the information became in force. Please note, this data element is distinct from the coverage period for the health plan as the insurance card may be provided in advance of the coverage start date or following the coverage start date (for example, in the event a replacement card is needed.)
Color Palette | This extension groups the Foreground, Background and Highlight color extensions into a single extension. When rendering foreground and background colors, the implementer should not use the same foreground and background colors and instead should algorithmically determine a high color contrast.
Cost Applies To Network Extension | Extension identifying the provider network whose providers qualify for a designation-tier cost-sharing amount, referencing one of the plan’s network Organizations
Deductible Applies Extension | Extension indicating whether a cost-sharing amount accrues to the plan deductible, corresponding to the deductible applicability information displayed in the SBC
Excluded Services Extension | Extension for documenting services that are not covered by the health insurance plan, as required in SBC ‘Excluded Services & Other Covered Services’ section
Foreground Color | This extension enables an insurance company to provide a foreground color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member. When rendering foreground and background colors, the implementer should not use the same foreground and background colors and instead should algorithmically determine a high color contrast.
Highlight Color | This extension enables an insurance company to provide a highlight color to be used by consuming applications when they render the information found on an insurance card for the insurance plan member. When rendering foreground and background colors, the implementer should not use the same foreground and background colors and instead should algorithmically determine a high color contrast.
Logo | This extension enables payers to provide an image of their company or organization logo for use by consuming applications when rendering the coverage information for use by the health plan member. This may assist in making the information provided feel more relevant or recongizable by the member. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.
Plan Beneficiaries | This extension allows for the representation of all of the members on the plan with corresponding Names and MemberIDs. This enables health plans to pass this information along with the Coverage resources to align with how this content is printed on physical insurance cards.
QR Code | This extension enables payers to provide an image of the QR code found on a member’s physicial insurance card. This image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. Often there are data elements relevant to the health plan coverage encoded in the QR code. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.
SBC Metadata Extension | Extension containing regulatory metadata required for Summary of Benefits and Coverage documents
Supporting image | This extension enables payers to provide other supporting images found on a member’s physicial insurance card. A supporting image may be displayed by consuming applications when rendering the coverage information for use by the health plan member. These images may communicate additional information to the member such as the type of coverage provided or partner logos. The extension also allows for the health plan to provide a Label for the image which can be displayed in the consuming application as well as a Description of the content in the image file. Detailed descriptions are encouraged to assist with accessibility.

### Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

C4DIC Contact Type | This value set includes an extended set of contact type codes.
C4DIC Copay Type | This value set includes an extended set of copay type codes.
C4DIC Coverage Class | This value set includes an extended set of coverage class codes.
C4DIC Coverage Identifier Type | Identifies the type of identifier for payer coverage
C4DIC ISO Color | ISO Color Measurement and Management
Cost Tier Value Set | Value set of cost-sharing tiers used to distinguish multiple cost amounts for the same benefit and network status, such as provider designation tiers or virtual care
Limit Period Value Set | Value set for the period over which a benefit limit accrues, such as plan year, calendar year, benefit period, or lifetime
Limit Type Value Set | Value set for the unit of measure of a benefit limit, such as visits, days, or dollars
SBC Benefit Category Value Set | Value set containing all 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents
SBC Plan Type Value Set | Value set containing health insurance plan types for Summary of Benefits and Coverage documents

### Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

C4DIC Extended Contact Type | This code system includes an extended set of Contact Type codes.
C4DIC Extended Copay Type | This code system includes an extended set of Copay Type codes.
C4DIC Extended Coverage Class | This code system includes an extended set of Coverage Class codes.
C4DIC Identifier Type | Identifier Type codes that extend those defined in http://terminology.hl7.org/CodeSystem/v2-0203 to define the type of identifier payers and providers assign to insurers and patients
Cost Tier Code System | Code system for cost-sharing tiers that distinguish multiple cost amounts for the same benefit and network status, based on provider designation or modality of care
Limit Period Code System | Code system for the period over which a benefit limit accrues
Limit Type Code System | Code system for the unit of measure of a benefit limit, such as visits, days, or dollars
SBC Benefit Category Code System | Code system for the 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents per ACA Section 2715 regulations
SBC Plan Type Code System | Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents

### Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

Coverage Example 1 | Coverage Example 1
Example Health Insurance Issuer | Example organization representing a health insurance issuer
Example SBC - Sample HMO Health Plan | Example Summary of Benefits and Coverage document represented as a FHIR InsurancePlan resource, demonstrating an HMO plan with multiple benefit categories and cost-sharing information
Example Value Choice Provider Network | Example organization representing the plan’s Value Choice provider network, referenced by designation-tier cost entries
Example-Coverage-FSH | Coverage Example 1 in FSH
Patient Example 1 | Patient Example 1 (subscriber)
Patient Example 2 | Patient Example 2 (beneficiary)
Payer Organization Example 1 | Payer Organization Example 1